Han Seung Seok, 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.
Ann Thorac Surg. 2017 Sep;104(3):804-810. doi: 10.1016/j.athoracsur.2017.01.075. Epub 2017 Apr 19.
A better prediction of postoperative acute kidney injury (AKI) is worthwhile in patients undergoing coronary artery bypass grafting (CABG) because AKI is associated with high rates of morbidity and mortality. The present study was performed to investigate whether preoperative C-reactive protein (CRP) predicted AKI and the long-term rate of mortality in CABG.
This retrospective cohort study included 1,656 patients whose high-sensitivity CRPs were measured before CABG at two tertiary referral centers from 2004 to 2010. The odds ratios and hazard ratios for AKI and all-cause mortality were measured according to the tertiles of CRP levels after the adjustment of multiple covariates. The net reclassification improvement and integrated discrimination improvement were calculated to determine whether the addition of CRP to the risk model improves predictive capacity. Patients were followed for 12 years.
The prevalence of AKI was increased in the third tertile group (42.7%) compared with in the first tertile group (25.6%). The corresponding odds ratio of AKI and p values were 1.86 (95% confidence interval: 1.39 to 2.49) and <0.001, respectively. Compared with the existing risk model, the addition of CRP improved the predictability with 0.135 of net reclassification improvement (p = 0.005) and 0.084 of integrated discrimination improvement (p < 0.001). There were 474 deaths (28.6%) during follow-up. The third tertile group exhibited a higher hazard ratio for mortality (1.63, 95% confidence interval: 1.27 to 2.08) than the first tertile group. This predictability for mortality remained consistent regardless of the presence of AKI.
Preoperative CRP level is a predictor of postoperative AKI and mortality in patients undergoing CABG.
对于接受冠状动脉旁路移植术（CABG）的患者，更好地预测术后急性肾损伤（AKI）是有价值的，因为AKI与高发病率和死亡率相关。本研究旨在调查术前C反应蛋白（CRP）是否可预测CABG患者的AKI及长期死亡率。
这项回顾性队列研究纳入了2004年至2010年在两个三级转诊中心接受CABG术前测量高敏CRP的1656例患者。在调整多个协变量后，根据CRP水平三分位数测量AKI和全因死亡率的优势比和风险比。计算净重新分类改善和综合鉴别改善，以确定将CRP添加到风险模型中是否能提高预测能力。对患者进行了12年的随访。
与第一三分位数组（25.6%）相比，第三三分位数组的AKI患病率增加（42.7%）。AKI的相应优势比和p值分别为1.86（95%置信区间：1.39至2.49）和<0.001。与现有风险模型相比，添加CRP可使预测能力提高，净重新分类改善为0.135（p = 0.005），综合鉴别改善为0.084（p < 0.001）。随访期间有474例死亡（28.6%）。第三三分位数组的死亡风险比（1.63，95%置信区间：1.27至2.08）高于第一三分位数组。无论是否存在AKI，这种对死亡率的预测能力均保持一致。
术前CRP水平是CABG患者术后AKI和死亡率的预测指标。
