Oliveira Marcos Aurélio Barboza de, Santos Carlos Alberto Dos, Brandi Antônio Carlos, Dotta Ana Helena, Botelho Paulo Henrique Husseini, Godoy Moacir Fernandes de, Braile Domingo M
Hospital Amecor, Cuiabá, MT, Brazil.
Hospital Femina Cuiabá, MT, Brazil.
Braz J Cardiovasc Surg. 2019 Mar-Apr;34(2):149-155. doi: 10.21470/1678-9741-2018-0261.
Renal function is an independent risk factor for mortality among on-pump coronary bypass grafting (ONCABG) patients. This association is well known in the international literature, but there is a lack of knowledge of how admission creatinine (AC) levels modulate each cardiovascular risk factor.
The aim of this paper was to assess the effect of different AC levels on mortality among ONCABG patients.
1,599 patients who underwent ONCABG between December 1999 and February 2006 at Hospital de Base in São José do Rio Preto/SP-Brazil were included. They were divided into quartiles according to their AC levels (QI: 0.2 ≤AC < 1.0 mg/dL; QII: 1.0 ≤ AC < 1.2 mg/dL; QIII: 1.2 ≤ AC < 1.4 mg/dL; and QIV: 1.4 ≤ AC ≤ 2.6 mg/dL). Seven risk factors were then evaluated in each stratum.
Mortality was higher in the QIV group than QI or QII groups. Factors such as age (≥ 65 years) and cardiopulmonary bypass (CPB) time (≥ 115 minutes) in QIV, as well preoperative hospital stay (≥ 5 days) in QIII, were associated with higher mortality rates. Creatinine variation greater than or equal to 0.4 mg/dL increased mortality rates in all groups. The use of intra-aortic balloon pump and dialysis increased mortality rates in all groups except for QII. Type I neurological dysfunction increased the mortality rate in the QII and III groups.
Creatinine levels play an important role in ONCABG mortality. The combination of selected risk factors and higher AC values leads to a worse prognosis. On the other hand, lower AC values were associated with a protective effect, even among elderly patients and those with a high CPB time.
肾功能是体外循环冠状动脉搭桥术（ONCABG）患者死亡的独立危险因素。这种关联在国际文献中已广为人知，但对于入院时肌酐（AC）水平如何调节各心血管危险因素却缺乏了解。
本文旨在评估不同AC水平对ONCABG患者死亡率的影响。
纳入1999年12月至2006年2月在巴西圣保罗州里奥普雷图市圣若泽多斯坎波斯市基础医院接受ONCABG手术的1599例患者。根据AC水平将他们分为四分位数（QI：0.2≤AC＜1.0mg/dL；QII：1.0≤AC＜1.2mg/dL；QIII：1.2≤AC＜1.4mg/dL；QIV：1.4≤AC≤2.6mg/dL）。然后在每个分层中评估七个危险因素。
QIV组的死亡率高于QI或QII组。QIV组中的年龄（≥65岁）和体外循环（CPB）时间（≥115分钟），以及QIII组中的术前住院时间（≥5天）等因素与较高的死亡率相关。肌酐变化大于或等于0.4mg/dL在所有组中均增加了死亡率。除QII组外，主动脉内球囊泵和透析的使用在所有组中均增加了死亡率。I型神经功能障碍在QII和III组中增加了死亡率。
肌酐水平在ONCABG死亡率中起重要作用。选定的危险因素与较高的AC值相结合会导致更差的预后。另一方面，较低的AC值具有保护作用，即使在老年患者和CPB时间较长的患者中也是如此。
