在接受冠状动脉旁路移植术的患者中，射血分数与心力衰竭和急性肾损伤的风险相关。
Heart failure and the risk of acute kidney injury in relation to ejection fraction in patients undergoing coronary artery bypass grafting.
机构信息
Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, University of Otago Christchurch, and Emergency Department Christchurch Hospital, Christchurch, New Zealand.
Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
出版信息
Int J Cardiol. 2019 Jan 1;274:66-70. doi: 10.1016/j.ijcard.2018.09.092. Epub 2018 Sep 28.
BACKGROUND
We studied the association between heart failure with reduced or preserved ejection fraction (EF) and the risk of acute kidney injury (AKI) in patients undergoing coronary artery bypass surgery (CABG).
METHODS
We included all patients who underwent isolated CABG in Sweden 2003 to 2013. AKI was defined according to the Kidney Disease Improving Global Outcomes definition, as an increase in postoperative serum creatinine concentration by ≥26 μmol/L or ≥50%, compared to preoperative values. Adjusted odds ratios (OR) for AKI were calculated using logistic regression for patients with and without heart failure, and among patients with heart failure, by EF categories (<30% severely reduced; 30-40% moderately reduced; ≥50% preserved).
RESULTS
Included were 36,403 patients of whom 3914 (11%) had heart failure. In patients with heart failure, 26% developed AKI compared with 14% in patients without heart failure. After adjustment for background characteristics, including preoperative kidney function and EF, the OR for AKI was 1.12 (95% CI 1.02-1.23) in patients with heart failure compared with no heart failure. Among patients with heart failure, the adjusted OR for AKI among patients with EF <30% vs. ≥50% was 1.32 (95% CI 1.06-1.65) and for 30-49% vs. ≥50% 1.06 (95% CI 0.87-1.28), respectively.
CONCLUSION
Patients with heart failure who underwent CABG had an increased risk for AKI postoperatively even after adjustment for comorbidity such as EF. Among patients with heart failure, having a severely reduced EF was associated with AKI compared to patents with preserved EF.
背景
我们研究了射血分数降低或保留的心力衰竭（HF）与接受冠状动脉旁路移植术（CABG）的患者发生急性肾损伤（AKI）的风险之间的关系。
方法
我们纳入了 2003 年至 2013 年期间在瑞典接受单纯 CABG 的所有患者。AKI 根据肾脏疾病改善全球结局（KDIGO）定义定义，即与术前相比，术后血清肌酐浓度增加≥26µmol/L 或≥50%。使用逻辑回归计算有和没有心力衰竭的患者以及心力衰竭患者中 EF 类别（<30%严重降低；30-40%中度降低；≥50%保留）的 AKI 调整比值比（OR）。
结果
共纳入 36403 例患者，其中 3914 例（11%）有心力衰竭。在心力衰竭患者中，26%发生 AKI，而无心力衰竭患者中为 14%。在校正背景特征（包括术前肾功能和 EF）后，与无心力衰竭患者相比，心力衰竭患者的 AKI OR 为 1.12（95%CI 1.02-1.23）。在心力衰竭患者中，EF<30%与 EF≥50%的 AKI 调整 OR 为 1.32（95%CI 1.06-1.65），30-49%与 EF≥50%的调整 OR 为 1.06（95%CI 0.87-1.28）。
结论
即使在校正 EF 等合并症后，接受 CABG 的心力衰竭患者术后发生 AKI 的风险也会增加。在心力衰竭患者中，与 EF 保留的患者相比，EF 严重降低与 AKI 相关。
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