Thongprayoon Charat, Cheungpasitporn Wisit, Mao Michael A, Srivali Narat, Kittanamongkolchai Wonngarm, Harrison Andrew M, Greason Kevin L, Kashani Kianoush B
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Medical Scientist Training Program, Mayo Clinic, Rochester, Minnesota.
J Card Surg. 2017 Sep;32(9):550-555. doi: 10.1111/jocs.13200. Epub 2017 Aug 22.
Acute kidney injury (AKI) and its severity after transcatheter aortic valve replacement (TAVR) have been associated with worse outcomes. Studies have shown that AKI duration (transient or persistent) affects outcomes independently of AKI severity. This study was undertaken to determine the association, risk factors, and outcomes associated with persistent AKI (pAKI) after TAVR.
Adult patients undergoing TAVR at Mayo Clinic between January 1, 2008 and June 30, 2014 were enrolled. pAKI was defined as an increased serum creatinine at hospital discharge (≥0.3 mg/dL or ≥50% from baseline). Risk factors associated with pAKI were identified with multivariate logistic regression.
A total of 386 patients met the inclusion criteria. Fifty patients (13%) had pAKI. Independent risk factors for pAKI on multivariate analysis included diabetes mellitus (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.29-4.66), prior percutaneous coronary intervention (PCI) (OR, 2.39; 95%CI, 1.24-4.80), intra-aortic balloon pump (IABP) use (OR, 8.14; 95%CI, 1.60-45.78), and blood transfusion (OR, 2.22; 95%CI, 1.15-4.27). Protective factors for pAKI included a higher baseline estimated glomerular filtration rate (eGFR) (OR, 0.83 per 10-mL/min/1.73 m increase in eGFR; 95%CI, 0.71-0.99). After adjusting for the Society of Thoracic Surgeons cardiac surgery risk score, pAKI occurrence remained significantly associated with increased 2-year mortality among hospital survivors (hazard ratio, 2.65; 95%CI, 1.51-4.41).
pAKI was significantly associated with higher mortality risk following TAVR. Baseline eGFR, diabetes mellitus, previous PCI, IABP, and blood transfusion were risk factors for post-procedural pAKI.
经导管主动脉瓣置换术（TAVR）后急性肾损伤（AKI）及其严重程度与更差的预后相关。研究表明，AKI持续时间（短暂性或持续性）独立于AKI严重程度影响预后。本研究旨在确定TAVR后持续性AKI（pAKI）的相关性、危险因素及预后。
纳入2008年1月1日至2014年6月30日在梅奥诊所接受TAVR的成年患者。pAKI定义为出院时血清肌酐升高（≥0.3mg/dL或较基线升高≥50%）。通过多因素逻辑回归确定与pAKI相关的危险因素。
共有386例患者符合纳入标准。50例患者（13%）发生pAKI。多因素分析中pAKI的独立危险因素包括糖尿病（比值比[OR]，2.43；95%置信区间[CI]，1.29 - 4.66）、既往经皮冠状动脉介入治疗（PCI）（OR，2.39；95%CI，1.24 - 4.80）、主动脉内球囊反搏（IABP）使用（OR，8.14；95%CI，1.60 - 45.78）及输血（OR，2.22；95%CI，1.15 - 4.27）。pAKI的保护因素包括更高的基线估计肾小球滤过率（eGFR）（eGFR每增加10 mL/min/1.73m²，OR为0.83；95%CI，0.71 - 0.99）。在调整胸外科医师协会心脏手术风险评分后，pAKI的发生与住院幸存者2年死亡率增加仍显著相关（风险比，2.65；95%CI，1.51 - 4.41）。
TAVR后pAKI与更高的死亡风险显著相关。基线eGFR、糖尿病、既往PCI、IABP及输血是术后pAKI的危险因素。
