Shiao Chih-Chung, Huang Ya-Ting, Lai Tai-Shuan, Huang Tao-Min, Wang Jian-Jhong, Huang Chun-Te, Wu Pei-Chen, Wu Che-Hsiung, Tsai I-Jung, Tseng Li-Jung, Wang Chih-Hsien, Chu Tzong-Shinn, Wu Kwan-Dun, Wu Vin-Cent
Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital Luodong, Yilan, Taiwan, R.O.C.
Saint Mary's Junior College of Medicine, Nursing and Management, Yilan, Taiwan, R.O.C.
PLoS One. 2017 Nov 17;12(11):e0187280. doi: 10.1371/journal.pone.0187280. eCollection 2017.
Postoperative acute kidney injury (AKI) is common following cardiac surgery (CS). Body weight (BW) may be an amenable variable by representing the summation of the nutritional and the fluid status. However, the predictive role of perioperative BW changes in CS patients with severe postoperative AKI is never explored. This study aimed to evaluate this association.
This study was conducted using a prospectively collected multicenter cohort, NSARF (National Taiwan University Hospital Study Group on Acute Renal Failure) database. The adult CS patients with postoperative AKI requiring renal replacement therapy (RRT), who had clear initial consciousness, received CS within 14 days of hospitalization, and underwent RRT within seven days after CS in intensive care units from January 2001 to January 2014 were enrolled. With the endpoint of 30-day postoperative mortality, we evaluated the association between the clinical factors denoting fluid status and patients outcomes.
A total of 188 patients (70 female, mean age 63.7 ± 15.2 years) were enrolled. Comparing with the survivors (n = 124), the non-survivors (n = 64) had a significantly higher perioperative BW change [3.6 ± 6.1% versus 0.1 ± 8.3%, p = 0.003] but not the postoperative and pre-RRT BW changes. By using multivariate Cox proportional hazards model, the independent indicators of 30-day postoperative mortality included perioperative BW change (p = 0.026) and packed red blood cells transfusion (p = 0.007), postoperative intra-aortic balloon pump (p = 0.001) and central venous pressure level (p = 0.005), as well as heart rate (p = 0.022), sequential organ failure assessment score (p < 0.001), logistic organ dysfunction score (p = 0.001), and blood total bilirubin level (p = 0.044) at RRT initiation. The generalized additive models further demonstrated, in a multivariate manner, that the mortality risk rose significantly during a perioperative BW change of 2% to 15%.
Perioperative BW change was independently associated with an increased risk for 30-day postoperative mortality in CS patients with RRT-requiring AKI.
心脏手术后急性肾损伤（AKI）很常见。体重（BW）可能是一个合适的变量，因为它代表了营养和液体状态的总和。然而，围手术期体重变化在需要进行肾脏替代治疗（RRT）的心脏手术患者术后严重AKI中的预测作用从未被探讨过。本研究旨在评估这种关联。
本研究使用前瞻性收集的多中心队列NSARF（国立台湾大学医院急性肾衰竭研究组）数据库。纳入2001年1月至2014年1月期间在重症监护病房接受心脏手术且术后AKI需要RRT、初始意识清醒、住院14天内接受心脏手术且心脏手术后7天内接受RRT的成年患者。以术后30天死亡率为终点，我们评估了表示液体状态的临床因素与患者预后之间的关联。
共纳入188例患者（70例女性，平均年龄63.7±15.2岁）。与幸存者（n = 124）相比，非幸存者（n = 64）围手术期体重变化显著更高[3.6±6.1%对0.1±8.3%，p = 0.003]，但术后和RRT前体重变化无差异。使用多变量Cox比例风险模型，术后30天死亡率的独立指标包括围手术期体重变化（p = 0.026）、红细胞输注（p = 0.007）、术后主动脉内球囊反搏（p = 0.001）和中心静脉压水平（p = 0.005），以及RRT开始时的心率（p = 0.022）、序贯器官衰竭评估评分（p < 0.001）、逻辑器官功能障碍评分（p = 0.001）和血总胆红素水平（p = 0.044）。广义相加模型进一步以多变量方式表明，围手术期体重变化在2%至15%期间死亡风险显著上升。
围手术期体重变化与需要RRT的心脏手术AKI患者术后30天死亡风险增加独立相关。
