Findik Orhan, Aydin Ufuk, Baris Ozgur, Parlar Hakan, Alagoz Gokcen Atilboz, Ata Yusuf, Turk Tamer, Kunt Atike Tekeli
Department of Cardiovascular Surgery, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.
Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey.
Heart Surg Forum. 2016 Jun 23;19(3):E123-7. doi: 10.1532/hsf.1577.
Acute kidney injury is a common complication of cardiac surgery that increases morbidity and mortality. The aim of the present study is to analyze the association of preoperative serum albumin levels with acute kidney injury and the requirement of renal replacement therapy after isolated coronary artery bypass graft surgery (CABG).
We retrospectively reviewed the prospectively collected data of 530 adult patients who underwent isolated CABG surgery with normal renal function. The perioperative clinical data of the patients included demographic data, laboratory data, length of stay, in-hospital complications and mortality. The patient population was divided into two groups: group I patients with preoperative serum albumin levels <3.5 mg/dL; and group II pateints with preoperative serum albumin levels ≥3.5 mg/dL.
There were 413 patients in group I and 117 patients in group II. Postoperative acute kidney injury (AKI) occured in 33 patients (28.2%) in group I and in 79 patients (19.1%) in group II. Renal replacement therapy was required in 17 patients (3.2%) (8 patients from group I; 9 patients from group II; P = .018). 30-day mortality occurred in 18 patients (3.4%) (10 patients from group I; 8 patients from group II; P = .037). Fourteen of these patients required renal replacement therapy. Logistic regression analysis revealing the presence of lower serum albumin levels preoperatively was shown to be associated with increased incidence of postoperative AKI (OR: 1.661; 95% CI: 1.037-2.661; P = .035). Logistic regression analysis also revealed that DM (OR: 3.325; 95% CI: 2.162-5.114; P = .000) was another independent risk factor for AKI after isolated CABG.
Low preoperative serum albumin levels result in severe acute kidney injury and increase the rate of renal replacement therapy and mortality after isolated CABG.
急性肾损伤是心脏手术常见的并发症，会增加发病率和死亡率。本研究旨在分析单纯冠状动脉搭桥术（CABG）术前血清白蛋白水平与急性肾损伤及肾脏替代治疗需求之间的关联。
我们回顾性分析了530例肾功能正常的成年患者接受单纯CABG手术的前瞻性收集数据。患者的围手术期临床数据包括人口统计学数据、实验室数据、住院时间、院内并发症和死亡率。患者人群分为两组：I组患者术前血清白蛋白水平<3.5mg/dL；II组患者术前血清白蛋白水平≥3.5mg/dL。
I组有413例患者，II组有117例患者。I组33例患者（28.2%）发生术后急性肾损伤（AKI），II组79例患者（19.1%）发生术后急性肾损伤。17例患者（3.2%）需要肾脏替代治疗（I组8例；II组9例；P = 0.018）。18例患者（3.4%）发生30天死亡率（I组10例；II组8例；P = 0.037）。其中14例患者需要肾脏替代治疗。逻辑回归分析显示术前血清白蛋白水平较低与术后AKI发生率增加相关（OR：1.661；95%CI：1.037 - 2.661；P = 0.035）。逻辑回归分析还显示，糖尿病（OR：3.325；95%CI：2.162 - 5.114；P = 0.000）是单纯CABG术后AKI的另一个独立危险因素。
术前血清白蛋白水平低会导致严重急性肾损伤，并增加单纯CABG术后肾脏替代治疗率和死亡率。
