Intensive Care Unit, Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Geneva, Switzerland.
Department of Renal Intensive Care Unit and Kidney Transplantation, Tenon University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; French National Institute of Health and Medical Research (INSERM), UMR_S1155, Rare and Common Kidney Diseases, Matrix Remodelling and Repair Department, Tenon Hospital, Paris, France.
Br J Anaesth. 2018 Nov;121(5):1025-1033. doi: 10.1016/j.bja.2018.07.033. Epub 2018 Sep 5.
Chronic kidney disease (CKD) is a frequent and serious complication of cardiac surgery. This study was designed to establish a scoring system, calculated in the immediate postoperative period, to assess the risk of CKD at 1 yr in patients undergoing cardiac surgery with cardiopulmonary bypass.
We conducted a cohort study including patients with preoperative estimated glomerular filtration rate above 60 ml min (1.73 m) who underwent cardiac surgery with cardiopulmonary bypass. We identified risk factors for de novo CKD at 1 yr using logistic regression. We derived a risk score for CKD, and externally validated this score in a second cohort.
The incidence of CKD was 18% and 23% in the derivation and validation cohorts, respectively. We developed a scoring system that included (i) the occurrence of postoperative acute kidney injury according to the Kidney Disease: Improving Global Outcomes criteria, (ii) age older than 65 yr, (iii) preoperative glomerular filtration rate <80 ml min (1.73 m), (iv) aortic cross-clamping time longer than 50 min, and (v) the type of surgery (aortic or cardiac transplantation). This score predicted CKD with good accuracy (area under the receiver operating characteristic curve: 0.81; 95% confidence interval: 0.77-0.86 in the derivation cohort), and with fair accuracy in the validation cohort (area under the receiver operating characteristic curve: 0.78; 95% confidence interval: 0.72-0.83).
We provide an easy-to-calculate scoring system to identify patients at high risk of developing CKD after cardiac surgery with cardiopulmonary bypass. This system might help clinicians to target more accurately patients requiring monitoring of renal function after cardiac surgery, and to design appropriate interventional trials aimed at preventing CKD or mitigating its consequences.
慢性肾脏病（CKD）是心脏手术后常见且严重的并发症。本研究旨在建立一种评分系统，该系统在体外循环心脏手术后即刻计算，以评估术后 1 年发生 CKD 的风险。
我们进行了一项队列研究，纳入了术前估算肾小球滤过率（eGFR）大于 60 ml/min（1.73 m）的接受体外循环心脏手术的患者。我们使用逻辑回归确定了术后 1 年新发 CKD 的危险因素。我们得出了 CKD 的风险评分，并在第二队列中进行了外部验证。
在推导队列和验证队列中，CKD 的发生率分别为 18%和 23%。我们开发了一种评分系统，包括（i）根据肾脏病：改善全球结果（KDIGO）标准发生的术后急性肾损伤，（ii）年龄大于 65 岁，（iii）术前 eGFR <80 ml/min（1.73 m），（iv）主动脉阻断时间长于 50 分钟，以及（v）手术类型（主动脉或心脏移植）。该评分对 CKD 具有较好的预测准确性（推导队列中受试者工作特征曲线下面积：0.81；95%置信区间：0.77-0.86），在验证队列中也具有较好的准确性（受试者工作特征曲线下面积：0.78；95%置信区间：0.72-0.83）。
我们提供了一种易于计算的评分系统，可识别接受体外循环心脏手术后发生 CKD 风险较高的患者。该系统可能有助于临床医生更准确地识别需要监测心脏手术后肾功能的患者，并设计出旨在预防 CKD 或减轻其后果的适当干预试验。
