Arthur Camila P S, Mejia Omar A V, Osternack Diogo, Nakazone Marcelo Arruda, Goncharov Maxim, Lisboa Luiz A F, Dallan Luís A O, Pomerantzeff Pablo M A, Jatene Fabio B
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Hospital de Base de São José do Rio Preto, São José do Rio Preto, SP, Brazil.
Arq Bras Cardiol. 2017 Oct;109(4):290-298. doi: 10.5935/abc.20170129. Epub 2017 Sep 4.
Renal dysfunction is an independent predictor of morbidity and mortality in cardiac surgery. For a better assessment of renal function, calculation of creatinine clearance (CC) may be necessary.
To objectively evaluate whether CC is a better risk predictor than serum creatinine (SC) in patients undergoing cardiac surgery.
Analysis of 3,285 patients registered in a prospective, consecutive and mandatory manner in the Sao Paulo Registry of Cardiovascular Surgery (REPLICCAR) between November 2013 and January 2015. Values of SC, CC (Cockcroft-Gault) and EuroSCORE II were obtained. Association analysis of SC and CC with morbidity and mortality was performed by calibration and discrimination tests. Independent multivariate models with SC and CC were generated by multiple logistic regression to predict morbidity and mortality following cardiac surgery.
Despite the association between SC and mortality, it did not calibrate properly the risk groups. There was an association between CC and mortality with good calibration of risk groups. In mortality risk prediction, SC was uncalibrated with values > 1.35 mg /dL (p < 0.001). The ROC curve showed that CC is better than SC in predicting both morbidity and mortality risk. In the multivariate model without CC, SC was the only predictor of morbidity, whereas in the model without SC, CC was not only a mortality predictor, but also the only morbidity predictor.
Compared with SC, CC is a better parameter of renal function in risk stratification of patients undergoing cardiac surgery.
肾功能不全是心脏手术发病率和死亡率的独立预测因素。为了更好地评估肾功能，可能需要计算肌酐清除率（CC）。
客观评估在接受心脏手术的患者中，CC是否比血清肌酐（SC）是更好的风险预测指标。
对2013年11月至2015年1月期间以前瞻性、连续性和强制性方式登记在圣保罗心血管外科登记处（REPLICCAR）的3285例患者进行分析。获取SC、CC（Cockcroft-Gault公式）和欧洲心脏手术风险评估系统II（EuroSCORE II）的值。通过校准和区分测试对SC和CC与发病率和死亡率进行关联分析。通过多因素逻辑回归生成包含SC和CC的独立多变量模型，以预测心脏手术后的发病率和死亡率。
尽管SC与死亡率之间存在关联，但它未能正确校准风险组。CC与死亡率之间存在关联，且风险组校准良好。在死亡率风险预测中，SC值>1.35mg/dL时未校准（p<0.001）。ROC曲线显示，CC在预测发病率和死亡率风险方面优于SC。在没有CC的多变量模型中，SC是发病率的唯一预测指标，而在没有SC的模型中，CC不仅是死亡率的预测指标，也是唯一的发病率预测指标。
与SC相比，CC是心脏手术患者风险分层中更好的肾功能参数。
