Han Seung Seok, Park Seokwoo, Kang Si-Hyuck, Cho Goo-Yeong, Kim Dong Ki, Kim Sejoong, Chin Ho Jun, Chae Dong-Wan, Na Ki Young
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
Am J Cardiol. 2017 Jan 15;119(2):231-236. doi: 10.1016/j.amjcard.2016.09.054. Epub 2016 Oct 7.
Acute kidney injury (AKI) is a common complication in patients undergoing coronary artery bypass grafting (CABG), which is associated with significant morbidity and mortality. This study identified echocardiographic predictors of AKI and determined whether these predictors were related to long-term mortality in CABG. This retrospective cohort study included 1,300 patients who underwent echocardiography before CABG at 2 tertiary referral centers from 2004 to 2010. The best echocardiographic predictor of AKI was determined using multivariate and stepwise selection methods. Patients were followed for 72 ± 28.8 months (maximum 11 years) for all-cause mortality. We measured the adjusted odds ratio and hazard ratio for AKI and all-cause mortality, respectively, according to the chosen parameter. E/e' was the best predictor of AKI among echocardiographic parameters. The high E/e' group (>15) exhibited a greater odds ratio for AKI (2.2 [1.51 to 3.27]) than the low E/e' group (<8). The high E/e' group required a longer hospital stay (16 days [12 to 23 days]) than the low E/e' group (14 days [11 to 17 days]). There were 272 deaths (21%) during follow-up. The high E/e' group exhibited a greater hazard ratio for long-term mortality (1.9 [1.34 to 2.76]) than the low E/e' group, and this difference remained statistically significant regardless of the occurrence of AKI and the size of the ejection fraction volume. E/e' in preoperative echocardiography is the best predictor of AKI and long-term mortality in patients undergoing CABG.
急性肾损伤（AKI）是接受冠状动脉旁路移植术（CABG）患者的常见并发症，与显著的发病率和死亡率相关。本研究确定了AKI的超声心动图预测指标，并确定这些预测指标是否与CABG患者的长期死亡率相关。这项回顾性队列研究纳入了2004年至2010年在2个三级转诊中心接受CABG术前超声心动图检查的1300例患者。使用多变量和逐步选择方法确定AKI的最佳超声心动图预测指标。对患者进行全因死亡率随访72±28.8个月（最长11年）。我们根据所选参数分别测量了AKI和全因死亡率的调整比值比和风险比。E/e'是超声心动图参数中AKI的最佳预测指标。高E/e'组（>15）的AKI比值比（2.2 [1.51至3.27]）高于低E/e'组（<8）。高E/e'组的住院时间（16天[12至23天]）比低E/e'组（14天[11至17天]）长。随访期间有272例死亡（21%）。高E/e'组的长期死亡率风险比（1.9 [1.34至2.76]）高于低E/e'组，无论是否发生AKI以及射血分数体积大小，这种差异均具有统计学意义。术前超声心动图中的E/e'是CABG患者AKI和长期死亡率的最佳预测指标。
