Hougardy Jean-Michel, Revercez Perrine, Pourcelet Aline, Oumeiri Bachar El, Racapé Judith, Le Moine Alain, Vanden Eynden Frédéric, De Backer Daniel
a Department of Nephrology , Hôpital Erasme, Université Libre De Bruxelles , Brussels , Belgium.
b Department of Cardiac Surgery , Hôpital Erasme, Université Libre De Bruxelles , Brussels , Belgium.
Acta Chir Belg. 2016 Aug;116(4):217-224. doi: 10.1080/00015458.2016.1156929. Epub 2016 Jun 2.
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication and is associated with the poorest outcomes. Therefore, early prediction of CSA-AKI remains a major issue. Severity scores such as the STS score could estimate the risk of AKI preoperatively. The main objective of this study was to evaluate the risk factors of on-pump CSA-AKI and to assess the performance of the STS score in order to predict CSA-AKI.
We identified 252 patients with on-pump cardiac surgery, and the STS score was defined retrospectively.
AKI occurred in 14.6% (n = 37/252) of patients and renal replacement therapy was required in 21.6% of AKI (n = 8/37). CSA-AKI was associated with 35.1% in-hospital mortality (vs. 1.4%) and nearly doubled length of stay (14.5 vs. 8.0 d). The risk of CSA-AKI was mainly determined by preoperative morbidities such as chronic kidney disease, peripheral vascular disease, and severe congestive heart failure. Long cardio-pulmonary bypass time was also a determinant. CSA-AKI + patients exhibited higher STS renal risk (5.6% vs. 2.0%; p < 0.0001), resulting in a good discrimination between AKI + and AKI - patients (area under curve [AUC] 0.80). Interestingly, a basal renal function ≤55 ml/min/1.73m was as good as the STS score to predict CSA-AKI (AUC 0.75; P 0.26).
On-pump CSA-AKI was observed in nearly 15% of cases and was associated with poorer outcomes. Interestingly, the risk of CSA-AKI could be estimated preoperatively, thanks to the basal renal function, which exhibited an equal performance to the STS score.
心脏手术相关急性肾损伤（CSA-AKI）是一种常见并发症，且与最差的预后相关。因此，CSA-AKI的早期预测仍然是一个主要问题。诸如胸外科医师协会（STS）评分等严重程度评分可在术前评估急性肾损伤的风险。本研究的主要目的是评估体外循环心脏手术CSA-AKI的危险因素，并评估STS评分预测CSA-AKI的性能。
我们纳入了252例行体外循环心脏手术的患者，并对STS评分进行回顾性定义。
14.6%（n = 37/252）的患者发生了急性肾损伤，21.6%的急性肾损伤患者（n = 8/37）需要肾脏替代治疗。CSA-AKI与35.1%的院内死亡率相关（相比之下为1.4%），住院时间几乎翻倍（14.5天对8.0天）。CSA-AKI的风险主要由术前疾病决定，如慢性肾病、外周血管疾病和严重充血性心力衰竭。较长的体外循环时间也是一个决定因素。CSA-AKI阳性患者表现出更高的STS肾脏风险（5.6%对2.0%；p < 0.0001），从而在急性肾损伤阳性和阴性患者之间实现了良好的区分（曲线下面积[AUC]为0.80）。有趣的是，基础肾功能≤55 ml/min/1.73m²在预测CSA-AKI方面与STS评分效果相当（AUC为0.75；P为0.26）。
近15%的病例观察到体外循环CSA-AKI，且与较差的预后相关。有趣的是，由于基础肾功能，CSA-AKI的风险可在术前进行评估，其表现与STS评分相当。
