Hansen Malene Kærslund, Gammelager Henrik, Jacobsen Carl-Johan, Hjortdal Vibeke Elisabeth, Layton J Bradley, Rasmussen Bodil Steen, Andreasen Jan Jesper, Johnsen Søren Paaske, Christiansen Christian Fynbo
Department of Clinical Epidemiology.
Department of Clinical Epidemiology; Department of Anaesthesiology and Intensive Care.
J Cardiothorac Vasc Anesth. 2015;29(3):617-25. doi: 10.1053/j.jvca.2014.08.020. Epub 2015 Jan 6.
To examine the impact of postoperative acute kidney injury (AKI) on the long-term risk of myocardial infarction, heart failure, stroke, and all-cause mortality after elective cardiac surgery. The authors investigated whether time of onset of AKI altered the association between AKI and the adverse events.
Population-based cohort study in 2006-2011.
Two university hospitals.
Adult elective cardiac surgical patients.
None.
AKI was defined as an increase in baseline creatinine according to the Kidney Disease Improving Global Outcomes criteria. AKI was defined within 30 days of surgery, and also analyzed as early- or late-onset AKI. The authors followed patients from postoperative day 30 until hospitalization with myocardial infarction, heart failure, stroke, or death. Adjustment for confounding factors was done using propensity scores and standardized-mortality-ratio weights. A total of 1,457 (30.7%) of 4,742 patients developed AKI within 30 days of surgery and 470 (9.9%) patients experienced a composite cardiovascular endpoint. Comparing patients with and without postoperative AKI, weighted hazard ratio (HR) and 95% confidence intervals (CI) of 5-year risk of the composite cardiovascular endpoint was 1.41 (95% CI: 1.11-1.80). For each endpoint separately the weighted HR was similarly increased. Ninety-one days to 5-year weighted HR of all-cause mortality was 1.37 (95% CI: 1.05-1.80). The effect of AKI was similar for early- and late-onset AKI.
Early- and late-onset AKI within 30 days of elective cardiac surgery was associated with a similarly increased 5-year risk of myocardial infarction, heart failure, stroke, and increased all-cause mortality.
探讨术后急性肾损伤（AKI）对择期心脏手术后心肌梗死、心力衰竭、中风及全因死亡长期风险的影响。作者调查了AKI的发病时间是否会改变AKI与不良事件之间的关联。
2006年至2011年基于人群的队列研究。
两家大学医院。
成年择期心脏手术患者。
无。
根据改善全球肾脏病预后组织（KDIGO）标准，AKI定义为基线肌酐水平升高。AKI定义为术后30天内发生，并分为早发型或晚发型AKI进行分析。作者对患者从术后第30天开始随访，直至发生心肌梗死、心力衰竭、中风或死亡住院。使用倾向评分和标准化死亡率比权重对混杂因素进行校正。4742例患者中有1457例（30.7%）在术后30天内发生AKI，470例（9.9%）患者发生复合心血管终点事件。比较有和无术后AKI的患者，复合心血管终点事件5年风险的加权风险比（HR）及95%置信区间（CI）为1.41（95%CI：1.11 - 1.80）。对于每个单独的终点，加权HR同样升高。全因死亡91天至5年的加权HR为1.37（95%CI：1.05 - 1.80）。早发型和晚发型AKI的影响相似。
择期心脏手术后30天内早发型和晚发型AKI均与心肌梗死、心力衰竭、中风5年风险相似增加及全因死亡率增加相关。
