Quality and Outcomes, Cardiothoracic Surgical Unit, Flinders Medical Centre, Adelaide, Australia; Perfusion Service, Cardiothoracic Surgical Unit, Flinders Medical Centre, Adelaide, Australia; Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
Quality and Outcomes, Cardiothoracic Surgical Unit, Flinders Medical Centre, Adelaide, Australia; Perfusion Service, Cardiothoracic Surgical Unit, Flinders Medical Centre, Adelaide, Australia; Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
Ann Thorac Surg. 2019 Dec;108(6):1807-1814. doi: 10.1016/j.athoracsur.2019.04.115. Epub 2019 Jun 22.
The randomized goal-directed perfusion trial confirmed retrospective findings that a goal-directed perfusion strategy to maintain oxygen delivery index (DOi) during cardiopulmonary bypass greater than 280 mL/min/m reduces the incidence of acute kidney injury (AKI). We developed a predictive model for AKI using data from the Australian and New Zealand Collaborative Perfusion Registry to determine whether these findings could be validated in a real-world clinical setting and to identify an optimal DOi threshold for predictive diagnostic accuracy.
Data in 19,410 cardiopulmonary bypass procedures were randomly divided into training (n = 9705) and validation (n = 9705) datasets. Multivariate logistic regression was used to determine the best predictive models for AKI (RIFLE [renal Risk, Injury, Failure, Loss of renal function and End-stage renal disease] classification), incremental predictive value of minimum cardiopulmonary bypass DOi, and optimal threshold.
Minimum DOi was significantly associated with any AKI, AKI risk, and AKI injury or greater class in both datasets (validation dataset; any AKI odds ratio [OR], 0.993; 95% confidence interval [CI], 0.991-0.995; P < .001; AKI risk OR, 0.994; 95% CI, 0.992-0.996; P < .001, AKI injury or greater 0.993; 95% CI, 0.991-0.996; P < .001), representing on average a 7% increase in the likelihood of AKI for every 10-mL/min/m decrease in DOi. Diagnostic accuracy was similar for both datasets, with an optimal DOi threshold of 270 mL/min/m. The odds of any AKI were increased by 52% in those below the threshold (OR, 1.52; 95% CI, 1.29-1.77; P < .001).
This study confirms previous findings that minimum DOi during cardiopulmonary bypass is independently associated with AKI, supporting previous findings in a broader-risk, multicenter cohort.
随机目标导向灌注试验证实了回顾性研究结果，即在体外循环期间维持氧输送指数（DOi）大于 280 mL/min/m 可降低急性肾损伤（AKI）的发生率。我们使用澳大利亚和新西兰协作灌注登记处的数据开发了 AKI 的预测模型，以确定这些发现是否可以在真实临床环境中得到验证，并确定最佳 DOi 阈值以实现预测诊断准确性。
将 19410 例体外循环手术的数据随机分为训练（n=9705）和验证（n=9705）数据集。多变量逻辑回归用于确定 AKI 的最佳预测模型（RIFLE[肾脏风险、损伤、衰竭、丧失肾功能和终末期肾病]分类）、最低体外循环 DOi 的增量预测值和最佳阈值。
在两个数据集（验证数据集；任何 AKI 比值比 [OR]，0.993；95%置信区间 [CI]，0.991-0.995；P <.001；AKI 风险 OR，0.994；95% CI，0.992-0.996；P <.001，AKI 损伤或更大 OR，0.993；95% CI，0.991-0.996；P <.001）中，最低 DOi 与任何 AKI、AKI 风险和 AKI 损伤或更高类别显著相关，这代表 DOi 每降低 10mL/min/m，AKI 的可能性平均增加 7%。两个数据集的诊断准确性相似，最佳 DOi 阈值为 270 mL/min/m。低于该阈值的任何 AKI 风险增加 52%（OR，1.52；95% CI，1.29-1.77；P <.001）。
本研究证实了先前的发现，即在体外循环期间最低 DOi 与 AKI 独立相关，支持了在更广泛风险、多中心队列中的先前发现。
