Xu D Q, Du J, Zheng Z, Tang Y, Zou L, Zhang Y H, Zhang H T
Cardiac Surgery ICU of Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100037, China.
Zhonghua Yi Xue Za Zhi. 2017 Jul 11;97(26):2033-2037. doi: 10.3760/cma.j.issn.0376-2491.2017.26.004.
To evaluate whether early postoperative serum uric acid level can predict postoperative acute renal injury (AKI) among patients undergoing coronary artery bypass grafting (CABG). The study retrospectively enrolled 1 306 patients undergoing CABG in Fuwai Hospital between September 2012 and December 2013. The patients were divided into 5 groups by the concentrations of serum uric acid measured on the morning of the first postoperative day, and uric acid categories were as follow: less than 195 μmol/L (Q1 group, 262 cases), 195-236 μmol/L (Q2 group, 263 cases), 237-280 μmol/L (Q3 group, 260 cases), 281-336 μmol/L (Q4 group, 261 cases), more than 336 μmol/L (Q5 group, 260 cases). The primary end points were AKI (RIFLE criteria), severe AKI (AKI≥stage Ⅰ), postoperative continuous renal replacement therapy (CRRT) requirement, in-hospital death, length of stay in hospital and intensive care unit(ICU). The area under the receiver-operating characteristic (ROC) curve (AUC) was used to determine the ability of the early postoperative serum uric acid level as a risk factor for postoperative AKI prediction. Among the 1 306 patients enrolled in the study, AKI was found in 335 patients (25.65%). After adjusting for variables that were different between the 5 groups, the Q5 group had significantly higher risk of AKI, AKI≥ stage Ⅰ and the requirement of CRRT (<0.01). The ROC for the outcome of postoperative AKI had an AUC of 0.648 (95% 0.612-0.683) when serum creatinine levels alone were used and 0.722 (95% 0.688-0.755) when serum uric acid levels alone were used (both <0.001). Early postoperative serum uric acid was a better predictor than serum creatinine(<0.001). The serum uric acid concentration within 12 hours after operation is an independent predictor of postoperative AKI in patients undergoing CABG, which could be used to identify patients at high risk for AKI.
评估冠状动脉旁路移植术（CABG）患者术后早期血清尿酸水平能否预测术后急性肾损伤（AKI）。本研究回顾性纳入了2012年9月至2013年12月期间在阜外医院接受CABG的1306例患者。根据术后第一天早晨测得的血清尿酸浓度将患者分为5组，尿酸类别如下：低于195μmol/L（Q1组，262例），195 - 236μmol/L（Q2组，263例），237 - 280μmol/L（Q3组，260例），281 - 336μmol/L（Q4组，2,61例），高于336μmol/L（Q5组，260例）。主要终点为AKI（RIFLE标准）、严重AKI（AKI≥Ⅰ期）、术后连续肾脏替代治疗（CRRT）需求、住院死亡、住院时间和重症监护病房（ICU）住院时间。采用受试者操作特征（ROC）曲线下面积（AUC）来确定术后早期血清尿酸水平作为术后AKI预测危险因素的能力。在纳入研究的1306例患者中，发现335例患者发生AKI（25.65%）。在对5组之间不同的变量进行校正后，Q5组发生AKI、AKI≥Ⅰ期和CRRT需求的风险显著更高（<0.01）。仅使用血清肌酐水平时，术后AKI结局的ROC曲线AUC为0.648（95% 0.612 - 0.683），仅使用血清尿酸水平时为0.722（95% 0.688 - 0.755）（均<0.001）。术后早期血清尿酸比血清肌酐是更好的预测指标（<0.001）。术后12小时内的血清尿酸浓度是CABG患者术后AKI的独立预测指标，可用于识别AKI高危患者。
