Karkouti Keyvan, Grocott Hilary P, Hall Richard, Jessen Michael E, Kruger Cornelis, Lerner Adam B, MacAdams Charles, Mazer C David, de Medicis Étienne, Myles Paul, Ralley Fiona, Rheault Michel R, Rochon Antoine, Slaughter Mark S, Sternlicht Andrew, Syed Summer, Waters Terrence
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, 3EN, Toronto, ON, M5G 2C4, Canada,
Can J Anaesth. 2015 Apr;62(4):377-84. doi: 10.1007/s12630-014-0302-y. Epub 2014 Dec 24.
Acute kidney injury (AKI) is a potentially serious complication of cardiac surgery. Anemia and red blood cell (RBC) transfusion have individually been identified as potentially modifiable risk factors, but their interrelationship with AKI has not been clearly defined. The purpose of this study was to explore the interrelationship of preoperative anemia, intraoperative anemia, and RBC transfusion on the day of surgery with AKI in cardiac surgery.
This historical cohort study included 16 hospitals, each contributing data on approximately 100 consecutive patients who underwent cardiac surgery with cardiopulmonary bypass. Acute kidney injury was defined as a > 50% increase in creatinine levels during the first postoperative week. Multivariable regression was used to identify the interrelationship between preoperative anemia (hemoglobin < 130 g·L(-1) in males and < 120 g·L(-1) in females), intraoperative anemia (hemoglobin < 80 g·L(-1) during cardiopulmonary bypass), RBC transfusion on the day of surgery, and their interaction terms, after adjusting for site and baseline AKI risk.
Of the 1,444 patients included in the study, 541 (37%) had preoperative anemia, 501 (35%) developed intraoperative anemia, 619 (43%) received RBC transfusions, and 238 (16%) developed AKI. After risk-adjustment, an individual with the combination of these three risk factors had a 2.6-fold (95% confidence interval 2.0 to 3.3) increase in the relative risk of AKI over an individual with none of these risk factors.
Preoperative anemia, intraoperative anemia, and RBC transfusion on the day of surgery are interrelated risk factors for AKI after cardiac surgery. Targeting these risk factors may reduce the burden of AKI.
急性肾损伤（AKI）是心脏手术潜在的严重并发症。贫血和红细胞（RBC）输血已分别被确定为潜在的可改变风险因素，但它们与AKI的相互关系尚未明确界定。本研究的目的是探讨术前贫血、术中贫血以及手术当天RBC输血与心脏手术中AKI的相互关系。
这项历史性队列研究纳入了16家医院，每家医院提供了约100例连续接受体外循环心脏手术患者的数据。急性肾损伤定义为术后第一周内肌酐水平升高>50%。在调整手术地点和基线AKI风险后，采用多变量回归分析来确定术前贫血（男性血红蛋白<130 g·L⁻¹，女性血红蛋白<120 g·L⁻¹）、术中贫血（体外循环期间血红蛋白<80 g·L⁻¹）、手术当天RBC输血及其交互项之间的相互关系。
在纳入研究的1444例患者中，541例（37%）有术前贫血，501例（35%）发生术中贫血，619例（43%）接受了RBC输血，238例（16%）发生了AKI。经过风险调整后，具有这三种风险因素组合的个体发生AKI的相对风险比没有这些风险因素的个体增加了2.6倍（95%置信区间2.0至3.3）。
术前贫血、术中贫血以及手术当天RBC输血是心脏手术后AKI的相互关联风险因素。针对这些风险因素可能会减轻AKI的负担。
