Gangadharan Sreja, Sundaram K R, Vasudevan Senthilvelan, Ananthakrishnan B, Balachandran Rakhi, Cherian Abraham, Varma Praveen Kerala, Gracia Luis Bakero, Murukan K, Madaiker Ashish, Jose Rajesh, Seetharaman Rakesh, Gopal Kirun, Menon Sujatha, Thushara M, Jose Reshmi Liza, Deepak G, Vanga Sudheer Babu, Jayant Aveek
Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
Department of Biostatistics, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
Ann Card Anaesth. 2018 Oct-Dec;21(4):448-454. doi: 10.4103/aca.ACA_21_18.
Acute kidney injury (AKI) after cardiac surgery (CS) is not uncommon and has serious effects on mortality and morbidity. A majority of patients suffer mild forms of AKI. There is a paucity of Indian data regarding this important complication after CS.
The primary objective was to study the incidence of AKI associated with CS in an Indian study population. Secondary objectives were to describe the risk factors associated with AKI-CS in our population and to generate outcome data in patients who suffer this complication.
Serial patients (n = 400) presenting for adult CS (emergency/elective) at a tertiary referral care hospital in South India from August 2016 to November 2017 were included as the study individuals. The incidence of AKI-CS AKI network (AKIN criteria), risk factors associated with this condition and the outcomes following AKI-CS are described.
Out of 400, 37 (9.25%) patients developed AKI after CS. AKI associated with CS was associated with a mortality of 13.5% (no AKI group mortality 2.8%, P = 0.001 [P < 0.05]). When AKI was severe enough to need renal replacement therapy, the mortality increased to 75%. Patients with AKI had a mean hospital stay 16.92 ± 12.75 days which was comparatively longer than patients without AKI (14 ± 7.98 days). Recent acute coronary syndrome, postoperative atrial fibrillation, and systemic hypertension significantly predicted the onset of AKI-CS in our population.
The overall incidence of AKI-CS was 9.25%. The incidence of AKI-CS requiring dialysis (Stage 3 AKIN) AKI-CS was lower (2%). However, mortality risks were disproportionately high in patients with AKIN Stage 3 AKI-CS (75%). There is a need for quality improvement in the care of patients with AKI-CS in its most severe forms since mortality risks posed by the development of Stage 3 AKIN AKI is higher than reported in other index populations from high resource settings.
心脏手术后急性肾损伤（AKI）并不少见，对死亡率和发病率有严重影响。大多数患者患有轻度AKI。关于心脏手术后这一重要并发症，印度的数据较少。
主要目的是在印度研究人群中研究与心脏手术相关的AKI的发病率。次要目的是描述我们人群中与心脏手术相关AKI（AKI - CS）的危险因素，并生成发生该并发症患者的结局数据。
纳入2016年8月至2017年11月在印度南部一家三级转诊医院接受成人心脏手术（急诊/择期）的连续患者（n = 400）作为研究对象。描述了心脏手术相关AKI（AKI网络，AKIN标准）的发病率、与该疾病相关的危险因素以及心脏手术相关AKI后的结局。
400例患者中，37例（9.25%）在心脏手术后发生AKI。心脏手术相关AKI的死亡率为13.5%（无AKI组死亡率为2.8%，P = 0.001[P < 0.05]）。当AKI严重到需要肾脏替代治疗时，死亡率升至75%。发生AKI的患者平均住院时间为16.92±12.75天，比未发生AKI的患者（14±7.98天）相对更长。近期急性冠状动脉综合征、术后心房颤动和系统性高血压显著预测了我们人群中心脏手术相关AKI的发生。
心脏手术相关AKI的总体发病率为9.25%。需要透析的心脏手术相关AKI（AKIN 3期）的发病率较低（2%）。然而，AKIN 3期心脏手术相关AKI患者的死亡风险极高（75%）。由于3期AKIN AKI发生带来的死亡风险高于来自高资源环境的其他对照人群报道，因此需要对最严重形式的心脏手术相关AKI患者的护理质量进行改善。
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