Yamauchi Takashi, Miyagawa Shigeru, Yoshikawa Yasushi, Toda Koichi, Sawa Yoshiki
Department of Cardiovascular Surgery, Osaka General Hospital, Osaka City, Osaka, Japan.
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Ann Thorac Surg. 2017 Sep;104(3):868-875. doi: 10.1016/j.athoracsur.2017.02.012. Epub 2017 Apr 29.
Acute kidney injury (AKI) after valvular surgical procedures with cardiopulmonary bypass carries potentially high mortality and morbidity rates. This study investigated the risk factors for AKI, and the study investigators developed a risk index to predict postoperative AKI.
A total of 1,484 consecutive non-dialysis-dependent patients who underwent valvular operations using cardiopulmonary bypass between 2008 and 2011 were retrospectively investigated. The definition of AKI is newly required temporary hemodialysis or a creatinine level greater than 2.0 mg/dL with more than twofold elevation compared with the preoperative value.
Postoperative AKI occurred in 91 patients (6.1%), among whom new dialysis dependence occurred in 45 patients (3.1%), resulting in hospital death in 22 patients (48.9%), discharge with renal function recovery in 19 (42.2%), and permanent dialysis dependence in 4 (8.9%). The overall hospital mortality rate was 3.9%. The mortality rate in patients with postoperative AKI-related complications and those who required new hemodialysis was 35.2% (32 of 91) and 48.9% (22 of 45), respectively, which was higher than in patients without AKI (1.9%; 26 of 1,393). Independent risk factors of postoperative AKI were smoking (odds ratio [OR], 2.008; p = 0.0151), diabetes mellitus (OR, 2.730; p = 0.0014), arteriosclerosis obliterans (OR, 4.351; p = 0.0317), congestive heart failure (OR, 2.455; p = 0.0052), estimated glomerular filtration rate less than or equal to 30 mL/min (OR, 4.855; p < 0.0001), and operation time longer than 8 hours (OR, 4.068; p = 0.0005). The risk index based on these risk factors predicted postoperative AKI (area under the curve, 0.81) and new requirement of hemodialysis (area under the curve, 0.86).
Based on these risk factors, the study investigators were able to predict the postoperative incidence of renal dysfunction after valvular operations with cardiopulmonary bypass.
体外循环下进行瓣膜手术术后发生急性肾损伤（AKI），其死亡率和发病率可能很高。本研究调查了AKI的危险因素，并由研究人员制定了一个风险指数来预测术后AKI。
对2008年至2011年间连续1484例接受体外循环瓣膜手术且无需透析的患者进行回顾性研究。AKI的定义为新出现的临时血液透析需求或肌酐水平大于2.0mg/dL，且较术前值升高两倍以上。
术后91例（6.1%）发生AKI，其中45例（3.1%）出现新的透析依赖，22例（48.9%）导致住院死亡，19例（42.2%）肾功能恢复出院，4例（8.9%）出现永久性透析依赖。总体住院死亡率为3.9%。术后发生AKI相关并发症及需要新的血液透析患者的死亡率分别为35.2%（91例中的32例）和48.9%（45例中的22例），高于未发生AKI的患者（1.9%；1393例中的26例）。术后AKI的独立危险因素为吸烟（比值比[OR]，2.008；p = 0.0151）、糖尿病（OR，2.730；p = 0.0014）、闭塞性动脉硬化（OR，4.351；p = 0.0317）、充血性心力衰竭（OR，2.455；p = 0.0052）、估计肾小球滤过率小于或等于30 mL/min（OR，4.855；p < 0.0001）以及手术时间超过8小时（OR，4.068；p = 0.0005）。基于这些危险因素的风险指数可预测术后AKI（曲线下面积，0.81）和新的血液透析需求（曲线下面积，0.86）。
基于这些危险因素，研究人员能够预测体外循环瓣膜手术后肾功能障碍的术后发生率。
