Li Zhiwei, Fan Guoliang, Zheng Xiaorong, Gong Xiaowen, Chen Tienan, Liu Xiaocheng, Jia Kegang
Department of Clinical Laboratory, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China.
School of Medical Laboratory, Tianjin Medical University, Tianjin, China.
Interact Cardiovasc Thorac Surg. 2019 Jun 1;28(6):893-899. doi: 10.1093/icvts/ivy353.
Our goal was to investigate risk factors for acute kidney injury (AKI) after coronary artery bypass grafting (CABG) and the impact of AKI on short-term outcomes.
Data on 1395 patients (1261 who had isolated CABG and 134 with other operations) who underwent non-emergent CABG from January 2013 to March 2016 were retrospectively collected from a single centre. Logistic regression was performed to analyse risk factors. Cox regression was used to analyse the impact of AKI on the postoperative 30-day death rate. A 1:1 propensity score matching was performed to balance the baseline characteristics.
The incidence of AKI with on-pump and off-pump coronary artery bypass was 10.4% and 3.5%, respectively. With logistic regression, duration of surgery was a risk factor for AKI (stage ≥2); previous hypertension, preoperative renal function insufficiency and the presence of cardiopulmonary bypass (CPB) were risk factors for mild AKI (stage ≥1). CPB time >207.5 min could be used to predict AKI (sensitivity 79.2%, specificity 78.6%) in the combined group. After adjusting for the duration of the operation, postoperative AKI (stage ≥1) was a risk factor for 30-day death and there was no difference in the 30-day death rate between on-pump and off-pump CABG.
The use of CPB was a risk factor for mild AKI that did not affect the 30-day death rate of CABG whereas moderate to severe AKI caused by prolonged CPB time associated with surgical complexity affected the 30-day death rate. AKI may indicate surgical injury. The decision to use the on- or off-pump technique does not affect the 30-day death rate of CABG.
我们的目标是研究冠状动脉旁路移植术（CABG）后急性肾损伤（AKI）的危险因素以及AKI对短期预后的影响。
回顾性收集了2013年1月至2016年3月在单一中心接受非急诊CABG的1395例患者（1261例单纯CABG患者和134例接受其他手术的患者）的数据。采用逻辑回归分析危险因素。使用Cox回归分析AKI对术后30天死亡率的影响。进行1:1倾向评分匹配以平衡基线特征。
体外循环和非体外循环冠状动脉旁路移植术的AKI发生率分别为10.4%和3.5%。通过逻辑回归分析，手术时间是AKI（≥2期）的危险因素；既往高血压、术前肾功能不全和体外循环（CPB）的使用是轻度AKI（≥1期）的危险因素。CPB时间>207.5分钟可用于预测联合组中的AKI（敏感性79.2%，特异性78.6%）。在调整手术时间后，术后AKI（≥1期）是30天死亡的危险因素，体外循环和非体外循环CABG的30天死亡率无差异。
CPB的使用是轻度AKI的危险因素，但不影响CABG的30天死亡率，而由与手术复杂性相关的CPB时间延长导致的中重度AKI影响30天死亡率。AKI可能提示手术损伤。使用体外循环或非体外循环技术的决定不影响CABG的30天死亡率。
