Division of Cardiovascular Sciences, University of Manchester, 2nd Floor ERC, Wythenshawe Hospital, Manchester University Hospitals Foundation Trust, M23 9LT, Manchester, UK.
Department of Cardiothoracic Anaesthesia and Critical Care, Wythenshawe Hospital, Manchester University Hospitals Foundation Trust, M23 9LT, Manchester, UK.
BMC Nephrol. 2018 Jun 25;19(1):149. doi: 10.1186/s12882-018-0946-x.
The Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury (AKI) guidelines assign the same stage of AKI to patients whether they fulfil urine output criteria, serum creatinine criteria or both criteria for that stage. This study explores the validity of the KDIGO guidelines as a tool to stratify the risk of adverse outcomes in cardiac surgery patients.
Prospective data from consecutive adult patients admitted to the cardiac intensive care unit (CICU) following cardiac surgery between January 2013 and May 2015 were analysed. Patients were assigned to groups based on the criteria they met for each stage of AKI according to the KDIGO guidelines. Short and mid-term outcomes were compared between these groups.
A total of 2267 patients were included with 772 meeting criteria for AKI-1 and 222 meeting criteria for AKI-2. After multivariable adjustment, patients meeting both urine output and creatinine criteria for AKI-1 were more likely to experience prolonged CICU stay (OR 4.9, 95%CI 3.3-7.4, p < 0.01) and more likely to require renal replacement therapy (OR 10.5, 95%CI 5.5-21.9, p < 0.01) than those meeting only the AKI-1 urine output criterion. Patients meeting both urine output and creatinine criteria for AKI-1 were at an increased risk of mid-term mortality compared to those diagnosed with AKI-1 by urine output alone (HR 2.8, 95%CI 1.6-4.8, p < 0.01). Patients meeting both urine output and creatinine criteria for AKI-2 were more likely to experience prolonged CICU stay (OR 16.0, 95%CI 3.2-292.0, p < 0.01) or require RRT (OR 11.0, 95%CI 4.2-30.9, p < 0.01) than those meeting only the urine output criterion. Patients meeting both urine output and creatinine criteria for AKI-2 were at a significantly increased risk of mid-term mortality compared to those diagnosed with AKI-2 by urine output alone (HR 3.6, 95%CI 1.4-9.3, p < 0.01).
Patients diagnosed with the same stage of AKI by different KDIGO criteria following cardiac surgery have significantly different short and mid-term outcomes. The KDIGO criteria need to be revisited before they can be used to stratify reliably the severity of AKI in cardiac surgery patients. The utility of the criteria also needs to be explored in other settings.
肾脏疾病：改善全球预后（KDIGO）急性肾损伤（AKI）指南将相同阶段的 AKI 分配给符合该阶段尿输出量标准、血清肌酐标准或同时符合这两个标准的患者。本研究探讨了 KDIGO 指南作为一种工具，用于对心脏手术后患者的不良结局风险进行分层的有效性。
前瞻性分析了 2013 年 1 月至 2015 年 5 月期间连续接受心脏手术后入住心脏重症监护病房（CICU）的成年患者的连续数据。根据 KDIGO 指南，根据每个 AKI 阶段的标准，将患者分为符合 AKI-1 标准的组和符合 AKI-2 标准的组。比较这些组之间的短期和中期结果。
共纳入 2267 例患者，其中 772 例符合 AKI-1 的尿输出量标准，222 例符合 AKI-2 的尿输出量标准。多变量调整后，同时符合 AKI-1 尿输出量和肌酐标准的患者更有可能经历延长的 CICU 住院时间（OR 4.9，95%CI 3.3-7.4，p<0.01），更有可能需要肾脏替代治疗（OR 10.5，95%CI 5.5-21.9，p<0.01），而仅符合 AKI-1 尿输出量标准的患者。同时符合 AKI-1 尿输出量和肌酐标准的患者与仅符合 AKI-1 尿输出量标准的患者相比，中期死亡率风险增加（HR 2.8，95%CI 1.6-4.8，p<0.01）。同时符合 AKI-2 尿输出量和肌酐标准的患者更有可能经历延长的 CICU 住院时间（OR 16.0，95%CI 3.2-292.0，p<0.01）或需要 RRT（OR 11.0，95%CI 4.2-30.9，p<0.01），而仅符合尿输出量标准的患者。同时符合 AKI-2 尿输出量和肌酐标准的患者与仅符合 AKI-2 尿输出量标准的患者相比，中期死亡率风险显著增加（HR 3.6，95%CI 1.4-9.3，p<0.01）。
心脏手术后，根据 KDIGO 不同标准诊断为相同阶段 AKI 的患者，短期和中期结果有显著差异。在将 KDIGO 标准可靠地用于分层心脏手术后 AKI 的严重程度之前，需要对其进行重新评估。还需要在其他环境中探索该标准的实用性。
