Kawahito Koji, Aizawa Kei, Oki Shinichi, Saito Tsutomu, Misawa Yoshio
Department of Cardiovascular Surgery, Jichi Medical School, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
J Artif Organs. 2016 Jun;19(2):134-40. doi: 10.1007/s10047-015-0883-4. Epub 2016 Jan 9.
Valve surgery in hemodialysis-dependent patients is associated with postoperative complications and a high mortality rate, and such patients frequently suffer cachexia. This study aimed to determine pre- and intraoperative risk factors associated with in-hospital mortality and long-term survival in hemodialysis-dependent patients undergoing heart valve surgery from the viewpoint of nutrition status. Eighty-seven hemodialysis-dependent patients who underwent valve surgery between January 1998 and October 2015 were retrospectively reviewed. Thirty-seven potential perioperative risk factors were evaluated. The in-hospital mortality rate was 12.6 % (11 patients). Univariate analysis identified New York Heart Association Functional Classification III or IV, emaciation (body mass index <17.6 kg/m(2)), total cholesterol <120 mg/dl, serum albumin <3.0 mg/dl, emergent/urgent surgery, and intraoperative blood transfusion >3000 ml as predictors of in-hospital death. Multivariate logistic regression analysis confirmed low serum albumin <3.0 mg/dl (hazard ratio 7.22; p = 0.032) and emergent/urgent operation (hazard ratio 43.57; p = 0.035) as independent predictors of in-hospital death. The 1- and 3-year actuarial survival rates were 64.9 ± 5.4 and 51.8 ± 5.8 %, respectively. Long-term survival estimated by log-rank test was negatively impacted by anemia (hemoglobin <10 mg/dl), low serum albumin, emergent/urgent operation, and infective endocarditis. Multivariate analysis using Cox proportional hazards modeling indicated low serum albumin (hazard ratio 2.12; p = 0.047) and emergent/urgent operation (hazard ratio 8.97; p = 0.0002) as independent predictors of remote death. Hypoalbuminemia and emergent/urgent operation are strong predictors of in-hospital and remote death. Malnutrition before surgery should be considered for operative risk estimation, and adequate preoperative nutrition management may improve surgical outcomes for hemodialysis-dependent patients.
依赖血液透析的患者进行瓣膜手术与术后并发症及高死亡率相关，且这类患者常伴有恶病质。本研究旨在从营养状况的角度确定依赖血液透析的患者接受心脏瓣膜手术时与住院死亡率和长期生存相关的术前及术中危险因素。对1998年1月至2015年10月期间接受瓣膜手术的87例依赖血液透析的患者进行回顾性分析。评估了37个潜在的围手术期危险因素。住院死亡率为12.6%（11例患者）。单因素分析确定纽约心脏协会心功能分级III或IV级、消瘦（体重指数<17.6kg/m²）、总胆固醇<120mg/dl、血清白蛋白<3.0mg/dl、急诊/紧急手术以及术中输血>3000ml为住院死亡的预测因素。多因素logistic回归分析证实血清白蛋白<3.0mg/dl（风险比7.22；p=0.032）和急诊/紧急手术（风险比43.57；p=0.035）是住院死亡的独立预测因素。1年和3年精算生存率分别为64.9±5.4%和51.8±5.8%。对数秩检验估计的长期生存受到贫血（血红蛋白<10mg/dl）、低血清白蛋白、急诊/紧急手术和感染性心内膜炎的负面影响。使用Cox比例风险模型进行的多因素分析表明低血清白蛋白（风险比2.12；p=0.047）和急诊/紧急手术（风险比8.97；p=0.0002）是远期死亡的独立预测因素。低蛋白血症和急诊/紧急手术是住院和远期死亡的强预测因素。术前应考虑营养不良对手术风险的评估，充分的术前营养管理可能改善依赖血液透析患者的手术结局。
