Oprea Adriana D, Lombard Frederick W, Liu Wen-Wei, White William D, Karhausen Jörn A, Li Yi-Ju, Miller Timothy E, Aronson Solomon, Gan Tong J, Fontes Manuel L, Kertai Miklos D
From the *Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut; †Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; ‡Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina; §Division of General, Vascular, and Transplant Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; and ‖Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York.
Anesth Analg. 2016 Dec;123(6):1480-1489. doi: 10.1213/ANE.0000000000001557.
Increased pulse pressure (PP) is an important independent predictor of cardiovascular outcome and acute kidney injury (AKI) after cardiac surgery. The objective of this study was to determine whether elevated baseline PP is associated with postoperative AKI and 30-day mortality after noncardiac surgery.
We evaluated 9125 adult patients who underwent noncardiac surgery at Duke University Medical Center between January 2006 and December 2009. Baseline arterial blood pressure was defined as the mean of the first 5 measurements recorded by the automated record keeping system before inducing anesthesia. Multivariable logistic regression analysis was performed to determine whether baseline PP adjusted for other perioperative risk factors was independently associated with postoperative AKI and 30-day mortality.
Of the 9125 patients, the baseline PP was <40 mm Hg in 1426 (15.6%), 40-80 mm Hg in 6926 (75.9%), and >80 mm Hg in 773 (8.5%) patients. The incidence of AKI was 19.8%, which included 8.4% (151 patients) and 4.2% (76 patients) who experienced stage II and III AKI, respectively. In the risk-adjusted model for postoperative AKI, elevated baseline PP was associated with higher odds for postoperative AKI (adjusted odds ratio [OR] for every 20 mm Hg increase in PP, 1.17; 95% confidence interval [CI], 1.10-1.25; P < .0001). Also elevated baseline preoperative PP was significantly associated with mild (stage I; OR, 1.19; 95% CI, 1.11-1.27; P < .0001), but not with more advanced stages of postoperative AKI or with an incremental risk for 30-day mortality.
We found a significant association between elevated baseline PP and postoperative AKI in patients who underwent noncardiac surgery. However, elevated PP was not significantly associated with more advanced stages of postoperative AKI or 30-day mortality in these patients.
脉压（PP）升高是心脏手术后心血管结局和急性肾损伤（AKI）的重要独立预测因素。本研究的目的是确定基线PP升高是否与非心脏手术后的术后AKI和30天死亡率相关。
我们评估了2006年1月至2009年12月在杜克大学医学中心接受非心脏手术的9125例成年患者。基线动脉血压定义为麻醉诱导前自动记录系统记录的前5次测量值的平均值。进行多变量逻辑回归分析，以确定调整其他围手术期危险因素后的基线PP是否与术后AKI和30天死亡率独立相关。
在9125例患者中，1426例（15.6%）的基线PP<40 mmHg，6926例（75.9%）的基线PP为40 - 80 mmHg，773例（8.5%）的基线PP>80 mmHg。AKI的发生率为19.8%，其中分别有8.4%（151例）和4.2%（76例）经历了II期和III期AKI。在术后AKI的风险调整模型中，基线PP升高与术后AKI的较高几率相关（PP每增加20 mmHg，调整后的优势比[OR]为1.17；95%置信区间[CI]，1.10 - 1.25；P <.0001）。此外，术前基线PP升高与轻度（I期；OR，1.19；95% CI，1.11 - 1.27；P <.0001）显著相关，但与术后AKI的更晚期阶段或30天死亡率的增加风险无关。
我们发现接受非心脏手术患者的基线PP升高与术后AKI之间存在显著关联。然而，PP升高与这些患者术后AKI的更晚期阶段或30天死亡率无显著关联。
