体重指数在心脏手术后急性肾损伤患者中的作用
Role of Body Mass Index in Acute Kidney Injury Patients after Cardiac Surgery.
作者信息
Zou Zhouping, Zhuang Yamin, Liu Lan, Shen Bo, Xu Jiarui, Luo Zhe, Teng Jie, Wang Chunsheng, Ding Xiaoqiang
机构信息
Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Cardiology Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
出版信息
Cardiorenal Med. 2017 Dec;8(1):9-17. doi: 10.1159/000477824. Epub 2017 Sep 16.
BACKGROUND/AIMS: To explore the association of body mass index (BMI) with the risk of developing acute kidney injury after cardiac surgery (CS-AKI) and for AKI requiring renal replacement therapy (AKI-RRT) after cardiac surgery.
METHODS
Clinical data of 8,455 patients undergoing cardiac surgery, including demographic preoperative, intraoperative, and postoperative data were collected. Patients were divided into underweight (BMI <18.5), normal weight (18.5≤ BMI <24), overweight (24≤ BMI <28), and obese (BMI ≥28) groups. The influence of BMI on CS-AKI incidence, duration of hospital, and intensive care unit (ICU) stays as well as AKI-related mortality was analyzed.
RESULTS
The mean age of the patients was 53.2 ± 13.9 years. The overall CS-AKI incidence was 33.8% ( = 2,855) with a hospital mortality of 5.4% ( = 154). The incidence of AKI-RRT was 5.2% ( = 148) with a mortality of 54.1% ( = 80). For underweight, normal weight, overweight, and obese cardiac surgery patients, the AKI incidences were 29.9, 31.0, 36.5, and 46.0%, respectively ( < 0.001). The hospital mortality of AKI patients in the 4 groups was 9.5, 6.0, 3.8, and 4.3%, whereas the hospital mortality of AKI-RRT patients in the 4 groups was 69.2, 60.8, 36.4, and 58.8%, both significantly different ( < 0.05). Hospital and ICU stay durations were not significantly different in the 4 BMI groups.
CONCLUSION
The hospital prognosis of AKI and AKI-RRT patients after cardiac surgery was best when their BMI was in the 24-28 range.
背景/目的：探讨体重指数（BMI）与心脏手术后发生急性肾损伤（CS-AKI）以及心脏手术后需要肾脏替代治疗的急性肾损伤（AKI-RRT）风险之间的关联。
方法
收集8455例接受心脏手术患者的临床资料，包括术前、术中和术后的人口统计学数据。患者分为体重过轻（BMI<18.5）、正常体重（18.5≤BMI<24）、超重（24≤BMI<28）和肥胖（BMI≥28）组。分析BMI对CS-AKI发生率、住院时间、重症监护病房（ICU）住院时间以及AKI相关死亡率的影响。
结果
患者的平均年龄为53.2±13.9岁。总体CS-AKI发生率为33.8%（n=2855），医院死亡率为5.4%（n=154）。AKI-RRT发生率为5.2%（n=148），死亡率为54.1%（n=80）。体重过轻、正常体重、超重和肥胖的心脏手术患者，AKI发生率分别为29.9%、31.0%、36.5%和46.0%（P<0.001）。4组中AKI患者的医院死亡率分别为9.5%、6.0%、3.8%和4.3%，而4组中AKI-RRT患者的医院死亡率分别为69.2%、60.8%、36.4%和58.8%，两者均有显著差异（P<0.05）。4个BMI组的住院和ICU住院时间无显著差异。
结论
心脏手术后AKI和AKI-RRT患者的BMI在24-28范围内时，医院预后最佳。
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