Section of Nephrology, Yale University School of Medicine, Veterans Affairs Medical Center, and the Program of Applied Translational Research, New Haven, Conn.
Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Ill.
J Thorac Cardiovasc Surg. 2014 Aug;148(2):726-32. doi: 10.1016/j.jtcvs.2013.09.080. Epub 2014 Apr 12.
Cardiac surgery is a major cause of acute kidney injury. In this setting, receipt of blood transfusions seems to be associated with a higher risk of acute kidney injury, as measured using serum creatinine values. We examined this association further by using urinary biomarkers of kidney injury.
A total of 1210 adults underwent cardiac surgery and were divided into 3 groups on the basis of the receipt of intraoperative packed red blood cell units: no blood (n = 894), 2 or less packed red blood cell units (n = 206), and more than 2 packed red blood cell units (n = 110). Acute kidney injury was defined as (1) doubling of serum creatinine from the preoperative value; (2) first postoperative urinary interleukin-18 in the fifth quintile; and (3) first postoperative urinary neutrophil gelatinase-associated lipocalin in the fifth quintile. We determined the relative risk for acute kidney injury outcome according to packed red blood cell units group after adjusting for 12 preoperative and surgical variables. By using the Sobel test for mediation analysis, we also evaluated the role of biomarkers in causing acute kidney injury through alternative pathways.
Acute kidney injury was more common in those who received more than 2 packed red blood cell units. In patients receiving more than 2 packed red blood cell units, the adjusted relative risks were 2.3 (95% confidence interval, 1.2-4.4, P .01), 1.36 (95% confidence interval, 1.0-1.9, P .05), and 1.34 (95% confidence interval, 1.0-1.8, P .06) for doubling of serum creatinine, urinary interleukin-18 in the fifth quintile (>60 pg/mL), and urinary neutrophil gelatinase-associated lipocalin in the fifth quintile (>102 ng/mL), respectively. Furthermore, the effect of packed red blood cell units transfusion on acute kidney injury was partially mediated by interleukin-18.
Receipt of 2 or more packed red blood cell units during cardiac surgery is associated with a greater risk of acute kidney injury defined by serum creatinine and kidney injury biomarkers.
心脏手术是急性肾损伤的主要原因。在这种情况下，接受输血似乎与急性肾损伤的风险增加有关，这可以通过血清肌酐值来衡量。我们通过使用肾脏损伤的尿生物标志物进一步研究了这种关联。
共有 1210 名成年人接受了心脏手术，并根据术中接受的单位浓缩红细胞数量分为 3 组：未输血（n=894）、接受 2 个或更少单位浓缩红细胞（n=206）和接受超过 2 个单位浓缩红细胞（n=110）。急性肾损伤的定义为：（1）血清肌酐值从术前值翻倍；（2）术后第 5 个五分位数的首次尿液白细胞介素-18；（3）术后第 5 个五分位数的首次尿液中性粒细胞明胶酶相关脂质运载蛋白。我们在调整了 12 个术前和手术变量后，根据浓缩红细胞单位数量组确定了急性肾损伤结果的相对风险。通过 Sobel 检验进行中介分析，我们还评估了生物标志物通过替代途径引起急性肾损伤的作用。
接受超过 2 个单位浓缩红细胞的患者中，急性肾损伤更为常见。在接受超过 2 个单位浓缩红细胞的患者中，调整后的相对风险分别为 2.3（95%置信区间，1.2-4.4，P<.01）、1.36（95%置信区间，1.0-1.9，P<.05）和 1.34（95%置信区间，1.0-1.8，P<.06），用于血清肌酐翻倍、尿液白细胞介素-18的第 5 个五分位数（>60pg/mL）和尿液中性粒细胞明胶酶相关脂质运载蛋白的第 5 个五分位数（>102ng/mL）。此外，浓缩红细胞单位输血对急性肾损伤的影响部分通过白细胞介素-18介导。
心脏手术期间接受 2 个或更多单位浓缩红细胞与通过血清肌酐和肾脏损伤生物标志物定义的急性肾损伤风险增加相关。
