Borracci Raul A, Macias Miranda Julio, Ingino Carlos A
Biostatistics, School of Medicine, Austral University, Buenos Aires, Argentina.
Department of Cardiology and Cardiac Surgery, ENERI-Sagrada Familia Clinic, Buenos Aires, Argentina.
J Card Surg. 2018 Nov;33(11):727-733. doi: 10.1111/jocs.13935. Epub 2018 Oct 23.
The objective of this study was to assess the incidence of in-hospital acute kidney injury (AKI) after cardiac surgery by comparing preoperative baseline renal function with renal function during the postoperative period and at discharge, and to relate these indices with in-hospital postoperative outcomes.
A retrospective analysis was performed over a 4-year period from a series of 426 adult patients. Kidney function was based on serum creatinine (SCr), Cockroft-Gault estimated creatinine clearance (eCrCl), and glomerular filtration rate estimated with the Modification of Diet in Renal Disease formula (eGFR). Baseline values were compared with "peak" values of altered kidney function postoperatively, and "discharge" values. In-hospital mortality and complication rates were compared between patients with transient and persistent AKI, and those without postoperative AKI.
After surgery, AKI (Risk-Injury-Failure-Loss-Endstage [RIFLE] classes Injury and Failure) was diagnosed in 14.6-17.5% of patients based on peak values. AKI diagnosis was reduced to 3.6-4.5% when SCr, eCrCl, and eGFR were measured at discharge. In-hospital mortality of patients with transient AKI was 4% versus 26% in patients with AKI at discharge (odds ratio = 0.11, 95% confidence interval 0.02-0.62, P = 0.011).
A diagnosis of AKI based on measurements of eGFR during the postoperative period was nearly four times more frequent than the same diagnosis at discharge. Transient AKI was the predominate presentation of postoperative kidney dysfunction in this study. Transient AKI did not affect in-hospital outcomes compared with patients without AKI. Patients with persistent AKI at discharge had the highest mortality.
本研究的目的是通过比较术前基线肾功能与术后及出院时的肾功能，评估心脏手术后院内急性肾损伤（AKI）的发生率，并将这些指标与术后院内结局相关联。
对426例成年患者进行了为期4年的回顾性分析。肾功能基于血清肌酐（SCr）、Cockcroft-Gault估计的肌酐清除率（eCrCl）以及用肾脏病饮食改良公式估算的肾小球滤过率（eGFR）。将基线值与术后肾功能改变的“峰值”以及“出院”值进行比较。比较了短暂性和持续性AKI患者与无术后AKI患者的院内死亡率和并发症发生率。
术后，根据峰值诊断AKI（风险-损伤-衰竭-丧失-终末期[RIFLE]分级中的损伤和衰竭）的患者比例为14.6%-17.5%。出院时测量SCr、eCrCl和eGFR时，AKI诊断率降至3.6%-4.5%。短暂性AKI患者的院内死亡率为4%，而出院时AKI患者的死亡率为26%（优势比=0.11，95%置信区间0.02-0.62，P=0.011）。
根据术后eGFR测量诊断的AKI比出院时诊断的频率高近四倍。在本研究中，短暂性AKI是术后肾功能障碍的主要表现形式。与无AKI的患者相比，短暂性AKI不影响院内结局。出院时持续性AKI的患者死亡率最高。
