冠状动脉搭桥手术后的血小板计数、急性肾损伤与死亡率
Platelet Counts, Acute Kidney Injury, and Mortality after Coronary Artery Bypass Grafting Surgery.
作者信息
Kertai Miklos D, Zhou Shan, Karhausen Jörn A, Cooter Mary, Jooste Edmund, Li Yi-Ju, White William D, Aronson Solomon, Podgoreanu Mihai V, Gaca Jeffrey, Welsby Ian J, Levy Jerrold H, Stafford-Smith Mark, Mathew Joseph P, Fontes Manuel L
机构信息
From the Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology (M.D.K., S.Z., J.A.K., M.C., E.J., W.D.W., S.A., M.V.P., I.J.W., J.H.L., M.S.-S., J.P.M.), Department of Biostatistics and Bioinformatics and Molecular Physiology Institute (Y.-J.L.), Division of Cardiovascular and Thoracic Surgery, Department of Surgery (J.G.), Duke University Medical Center, Durham, North Carolina; and Division of Cardiac Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut (M.L.F.).
出版信息
Anesthesiology. 2016 Feb;124(2):339-52. doi: 10.1097/ALN.0000000000000959.
BACKGROUND
Cardiac surgery requiring cardiopulmonary bypass is associated with platelet activation. Because platelets are increasingly recognized as important effectors of ischemia and end-organ inflammatory injury, the authors explored whether postoperative nadir platelet counts are associated with acute kidney injury (AKI) and mortality after coronary artery bypass grafting (CABG) surgery.
METHODS
The authors evaluated 4,217 adult patients who underwent CABG surgery. Postoperative nadir platelet counts were defined as the lowest in-hospital values and were used as a continuous predictor of postoperative AKI and mortality. Nadir values in the lowest 10th percentile were also used as a categorical predictor. Multivariable logistic regression and Cox proportional hazard models examined the association between postoperative platelet counts, postoperative AKI, and mortality.
RESULTS
The median postoperative nadir platelet count was 121 × 10/l. The incidence of postoperative AKI was 54%, including 9.5% (215 patients) and 3.4% (76 patients) who experienced stages II and III AKI, respectively. For every 30 × 10/l decrease in platelet counts, the risk for postoperative AKI increased by 14% (adjusted odds ratio, 1.14; 95% CI, 1.09 to 1.20; P < 0.0001). Patients with platelet counts in the lowest 10th percentile were three times more likely to progress to a higher severity of postoperative AKI (adjusted proportional odds ratio, 3.04; 95% CI, 2.26 to 4.07; P < 0.0001) and had associated increased risk for mortality immediately after surgery (adjusted hazard ratio, 5.46; 95% CI, 3.79 to 7.89; P < 0.0001).
CONCLUSION
The authors found a significant association between postoperative nadir platelet counts and AKI and short-term mortality after CABG surgery.
背景
需要体外循环的心脏手术与血小板活化有关。由于血小板越来越被认为是缺血和终末器官炎性损伤的重要效应器，作者探讨了冠状动脉旁路移植术（CABG）术后血小板计数最低点是否与急性肾损伤（AKI）及死亡率相关。
方法
作者评估了4217例接受CABG手术的成年患者。术后血小板计数最低点定义为住院期间的最低值，并用作术后AKI和死亡率的连续预测指标。最低十分位数的最低点值也用作分类预测指标。多变量逻辑回归和Cox比例风险模型检验了术后血小板计数、术后AKI和死亡率之间的关联。
结果
术后血小板计数最低点的中位数为121×10⁹/L。术后AKI的发生率为54%，其中分别有9.5%（215例患者）和3.4%（76例患者）发生II期和III期AKI。血小板计数每降低30×10⁹/L，术后AKI的风险增加14%（校正比值比，1.14；95%CI，1.09至1.20；P<0.0001）。血小板计数处于最低十分位数的患者进展为更高严重程度术后AKI的可能性是其他患者的三倍（校正比例比值比，3.04；95%CI，2.26至4.07；P<0.0001），且术后立即死亡的风险也相应增加（校正风险比，5.46；95%CI，3.79至7.89；P<0.0001）。
结论
作者发现CABG术后血小板计数最低点与AKI及短期死亡率之间存在显著关联。
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