术后输血是心脏手术患者急性肾损伤的独立预测因素。
Postoperative blood transfusion is an independent predictor of acute kidney injury in cardiac surgery patients.
作者信息
Freeland Kristofer, Hamidian Jahromi Alireza, Duvall Lucas Maier, Mancini Mary Catherine
机构信息
Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
出版信息
J Nephropathol. 2015 Oct;4(4):121-6. doi: 10.12860/jnp.2015.23. Epub 2015 Oct 1.
BACKGROUND
Acute kidney injury (AKI) is a serious complication of cardiac surgery with cardiopulmonary bypass (CPB) which increases postoperative morbidity and mortality.
OBJECTIVES
The study was designed to assess the incidence of AKI and associated risk factors in patients undergoing CPB ancillary to coronary artery bypass grafting (CABG), valve surgery, and combined CABG and valve surgery.
PATIENTS AND METHODS
This Intuitional Review Board (IRB) approved retrospective study included patients with normal preoperative kidney function (Serum creatinine [sCr] <2.0 mg/dl) who underwent cardiac surgery with CPB between 2012 and 2014. Patients were divided into 2 groups: group I: Patients with cardiac surgery associated AKI (CS-AKI) (postoperative sCr >2 mg/dl with a minimal doubling of baseline sCr) and group II: Patients with a normal postoperative kidney function. Demographic data, body mass index (BMI), co-morbidities, hematologic/biochemical profiles, preoperative ejection fraction (%EF), blood transfusion history, and operative data were compared between the groups. Mean arterial pressure (MAP) was recorded during the operation and in the postoperative period. Δ-MAP was defined as the difference between pre-CPB-MAP and the CPB-MAP.
RESULTS
241 patients matched the inclusion criteria (CS-AKI incidence = 8.29%). Age, gender, BMI, %EF, and co-morbidities were not predictors of CS-AKI (P > 0.05). High preoperative sCr (P = 0.047), type of procedure (P = 0.04), clamp time (P = 0.003), pump time (P = 0.005) and history of blood transfusion within 14 days postsurgery (P = 0.0004) were associated with risk of CS-AKI. Pre-CPB-MAP, CPB-MAP, Δ-MAP, and ICU-MAP were not significantly different between the 2 groups. Male gender (OR: 5.53; P = 0.048), age>60 (OR: 4.54; P = 0.027) and blood transfusion after surgery (OR: 5.25; P = 0.0054) were independent predictors for postoperative AKI.
CONCLUSIONS
Age, gender and blood transfusion were independent predictors of cardiac surgery associated AKI.
背景
急性肾损伤（AKI）是心脏直视手术（CPB）的一种严重并发症，会增加术后发病率和死亡率。
目的
本研究旨在评估接受冠状动脉旁路移植术（CABG）、瓣膜手术以及CABG与瓣膜联合手术的CPB患者中AKI的发生率及相关危险因素。
患者与方法
本研究经机构审查委员会（IRB）批准，为回顾性研究，纳入2012年至2014年间术前肾功能正常（血清肌酐[sCr]<2.0mg/dl）且接受CPB心脏手术的患者。患者分为两组：第一组：心脏手术相关急性肾损伤（CS-AKI）患者（术后sCr>2mg/dl且基线sCr至少翻倍）；第二组：术后肾功能正常的患者。比较两组患者的人口统计学数据、体重指数（BMI）、合并症、血液学/生化指标、术前射血分数（%EF）、输血史及手术数据。记录手术期间及术后的平均动脉压（MAP）。Δ-MAP定义为CPB前MAP与CPB期间MAP的差值。
结果
241例患者符合纳入标准（CS-AKI发生率=8.29%）。年龄、性别、BMI、%EF及合并症不是CS-AKI的预测因素（P>0.05）。术前高sCr（P=0.047）、手术类型（P=0.04）、阻断时间（P=0.003）、体外循环时间（P=0.005）及术后14天内输血史（P=0.0004）与CS-AKI风险相关。两组间CPB前MAP、CPB期间MAP、Δ-MAP及ICU-MAP无显著差异。男性（OR：5.53；P=0.048）、年龄>60岁（OR：4.54；P=0.027）及术后输血（OR：5.25；P=0.0054）是术后AKI的独立预测因素。
结论
年龄、性别及输血是心脏手术相关急性肾损伤的独立预测因素。
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