Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Department of Critical Care Medicine, Center for Critical Care Nephrology, Pittsburgh, Pennsylvania.
Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Ann Thorac Surg. 2019 May;107(5):1416-1420. doi: 10.1016/j.athoracsur.2019.01.017. Epub 2019 Feb 11.
There is an increasing number of young adults living with congenital heart disease (CHD). The goal of this study was to ascertain the frequency of acute kidney injury (AKI) as well as the risk factors and outcomes associated with AKI in young adults with CHD after a surgical procedure.
This was a single-center retrospective cohort study including all patients 18 to 40 years of age with a diagnosis of CHD admitted to a quaternary care children's hospital cardiac intensive care unit postoperatively from 2004 to 2015. We defined AKI using the Kidney Disease Improving Global Outcomes criteria for serum creatinine. We explored potential susceptibilities and exposures for AKI using multivariable logistic regression and determined the association of AKI with duration of mechanical ventilation and length of stay using Poisson regression.
In 699 consecutively admitted patients AKI occurred in 13.2%. Suspected sepsis (odds ratio [OR], 2.87; 95% confidence interval [CI], 1.17 to 7.05), exposure to calcineurin inhibitors (OR, 5.80; 95% CI, 1.06 to 31.59), vancomycin (OR, 3.35; 95% CI, 1.11 to 10.14), and piperacillin-tazobactam (OR, 4.12; 95% CI, 1.23 to 13.78) increased the odds of AKI even after controlling for age, ejection fraction, recent cardiac catheterization, repeat cardiopulmonary bypass, bypass time, cross-clamp time, and other potential nephrotoxic medications. AKI was associated with a longer duration of mechanical ventilation (OR, 1.47; 95% CI, 1.15 to 1.89) and intensive care unit length of stay (OR, 1.50; 95% CI, 1.30 to 1.72).
AKI is common in young adults with CHD postoperatively and is associated with negative outcomes. The results highlight the importance future research and clinical efforts aimed at prevention and improved management of AKI in this patient group.
患有先天性心脏病 (CHD) 的年轻人数量不断增加。本研究的目的是确定手术后患有 CHD 的年轻成年人中急性肾损伤 (AKI) 的频率以及与 AKI 相关的风险因素和结局。
这是一项单中心回顾性队列研究，纳入 2004 年至 2015 年期间在一家四级儿童医院心脏重症监护病房接受心脏手术后年龄在 18 至 40 岁之间的所有 CHD 患者。我们使用血清肌酐的肾脏病改善全球结局标准定义 AKI。我们使用多变量逻辑回归探索 AKI 的潜在易感性和暴露因素，并使用泊松回归确定 AKI 与机械通气时间和住院时间的相关性。
在 699 例连续入院的患者中，有 13.2%发生 AKI。疑似败血症（比值比 [OR]，2.87；95%置信区间 [CI]，1.17 至 7.05）、使用钙调磷酸酶抑制剂（OR，5.80；95% CI，1.06 至 31.59）、万古霉素（OR，3.35；95% CI，1.11 至 10.14）和哌拉西林他唑巴坦（OR，4.12；95% CI，1.23 至 13.78）增加了 AKI 的可能性，即使在控制年龄、射血分数、近期心导管检查、重复心肺转流、体外循环时间、体外循环夹闭时间和其他潜在肾毒性药物后也是如此。AKI 与机械通气时间延长（OR，1.47；95% CI，1.15 至 1.89）和重症监护病房住院时间延长（OR，1.50；95% CI，1.30 至 1.72）相关。
术后患有 CHD 的年轻成年人中 AKI 很常见，并且与不良结局相关。结果强调了未来研究和临床努力的重要性，旨在预防和改善该患者群体的 AKI 管理。
