Kaufeld T, Foerster K A, Schilling T, Kielstein J T, Kaufeld J, Shrestha M, Haller H G, Haverich A, Schmidt B M W
Department of Heart, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Str.1, Hannover, 30625, Germany.
BMC Nephrol. 2018 Jul 4;19(1):161. doi: 10.1186/s12882-018-0970-x.
Acute kidney injury (AKI) following cardiac surgery is a frequent complication and several risk factors increasing its incidence have already been characterized. This study evaluates the influence of preoperative increased serum uric acid (SUA) levels in comparison with other known risk factors on the incidence of AKI following cardiac surgery.
During a period of 5 month, 247 patients underwent elective coronary artery bypass grafting, valve replacement/ repair or combined bypass and valve surgery. Datas were prospectively analyzed. Primary endpoint was the incidence of AKI as defined by the AKI criteria comparing patients with preoperative serum uric acid (SUA) levels below versus above the median. Multivariate logistic regression analysis was used to identify independent predictors of postoperative AKI.
Thirty (12.1%) of the 247 patients developed postoperative AKI, 24 of 30 (80%) had preoperative SUA- levels above the median (≥373 μmol/l) (OR: 4.680, CI 95% 1.840; 11.904, p = 0.001). In the multivariate analysis SUA levels above the median (OR: 5.497, CI 95% 1.772; 17.054, p = 0.003), cardiopulmonary bypass (CPB) time > 90 min (OR: 4.595, CI 95% 1.587; 13.305, p = 0.005), cardiopulmonary bypass (CPB) > 30 kg/m (OR: 3.208, CI 95% 1.202; 8.562; p = 0.02), and preoperative elevated serum-creatinine levels (OR: 1.015, CI 95% 1.001; 1.029, p = 0.04) were independently associated with postoperative AKI.
Serum uric acid is an independent risk marker for AKI after cardiac surgery. From all evaluated factors it showed the highest odds ratio.
心脏手术后急性肾损伤（AKI）是一种常见并发症，已经确定了几种增加其发生率的危险因素。本研究评估术前血清尿酸（SUA）水平升高与其他已知危险因素相比，对心脏手术后AKI发生率的影响。
在5个月期间，247例患者接受了择期冠状动脉搭桥术、瓣膜置换/修复术或搭桥与瓣膜联合手术。对数据进行前瞻性分析。主要终点是根据AKI标准定义的AKI发生率，比较术前血清尿酸（SUA）水平低于和高于中位数的患者。采用多因素逻辑回归分析确定术后AKI的独立预测因素。
247例患者中有30例（12.1%）发生术后AKI，30例中的24例（80%）术前SUA水平高于中位数（≥373μmol/l）（比值比：4.680，95%可信区间1.840；11.904，p = 0.001）。在多因素分析中，SUA水平高于中位数（比值比：5.497，95%可信区间1.772；17.054，p = 0.003）、体外循环（CPB）时间>90分钟（比值比：4.595，95%可信区间1.587；13.305，p = 0.005）、体外循环（CPB）>30kg/m（比值比：3.208，95%可信区间1.202；8.562；p = 0.02）以及术前血清肌酐水平升高（比值比：1.015，95%可信区间1.001；1.029，p = 0.04）与术后AKI独立相关。
血清尿酸是心脏手术后AKI的独立危险因素。在所有评估因素中，它显示出最高的比值比。
