Brown Jeremiah R, Hisey William M, Marshall Emily J, Likosky Donald S, Nichols Elizabeth L, Everett Allen D, Pasquali Sara K, Jacobs Marshall L, Jacobs Jeff P, Parikh Chirag R
Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire; Department of Medicine, Geisel School of Medicine, Lebanon, New Hampshire.
Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire.
Ann Thorac Surg. 2016 Nov;102(5):1482-1489. doi: 10.1016/j.athoracsur.2016.04.020. Epub 2016 Jun 17.
Acute kidney injury (AKI) is a common complication after cardiac surgery. While AKI severity is known to be associated with increased risk of short-term outcomes, its long-term impact is less well understood.
Adult patients undergoing isolated coronary artery bypass graft surgery at eight centers were enrolled into the Northern New England biomarker registry (n = 1,610). Patients were excluded if they had renal failure (n = 15) or died during index admission (n = 38). Severity of AKI was defined using the Acute Kidney Injury Network (AKIN). We linked our cohort to national Medicare and state all-payer claims to ascertain readmissions and to the National Death Index to ascertain survival. Kaplan-Meier and multivariate Cox proportional hazards modeling was conducted for time to readmission and death over 5 years.
Within 5 years, 513 patients (33.8%) had AKI with AKIN stage 1 (29.9%) and stage 2 to 3 (3.9%). There were 620 readmissions (39.9%) and 370 deaths (23.8%). After adjustment, stage 1 AKI patients had a 31% increased risk of readmission (95% confidence interval [CI]: 1.10 to 1.57), whereas stage 2 or 3 patients had a 98% increased risk (95% CI: 1.41 to 2.78) compared with patients having no AKI. Relative to patients without AKI, stage 1 patients had a 56% increased risk of mortality (95% CI: 1.14 to 2.13), whereas stage 2 or 3 patients had a 3.5 times higher risk (95% CI: 2.16 to 5.60).
Severity of AKI using the AKIN stage criteria is associated with a significantly increased risk of 5-year readmission and mortality. Our findings suggest that efforts to reduce AKI in the perioperative period may have a significant long-term impact on patients and payers in reducing mortality and health care utilization.
急性肾损伤（AKI）是心脏手术后常见的并发症。虽然已知AKI的严重程度与短期预后风险增加有关，但其长期影响尚不太清楚。
在八个中心接受单纯冠状动脉搭桥手术的成年患者被纳入新英格兰北部生物标志物登记处（n = 1,610）。如果患者有肾衰竭（n = 15）或在首次入院期间死亡（n = 38），则将其排除。使用急性肾损伤网络（AKIN）定义AKI的严重程度。我们将我们的队列与国家医疗保险和州所有支付方的索赔数据相链接，以确定再入院情况，并与国家死亡指数相链接以确定生存率。对5年内的再入院时间和死亡时间进行了Kaplan-Meier分析和多变量Cox比例风险建模。
在5年内，513名患者（33.8%）发生了AKI，其中AKIN 1期（29.9%）和2至3期（3.9%）。有620次再入院（39.9%）和370例死亡（23.8%）。调整后，与无AKI的患者相比，1期AKI患者再入院风险增加31%（95%置信区间[CI]：1.10至1.57），而2期或3期患者再入院风险增加98%（95%CI：1.41至2.78）。相对于无AKI的患者，1期患者死亡风险增加56%（95%CI：1.14至2.13），而2期或3期患者死亡风险高3.5倍（95%CI：2.16至5.60）。
使用AKIN分期标准的AKI严重程度与5年再入院和死亡风险显著增加相关。我们的研究结果表明，围手术期减少AKI的努力可能对患者和支付方在降低死亡率和医疗保健利用率方面产生重大的长期影响。
