Pilarczyk Kevin, Carstens Henning, Papathanasiou Maria, Luedike Peter, Koch Achim, Jakob Heinz, Kamler Markus, Pizanis Nikolaus
Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
Department of Critical Care Medicine, imland Klinik Rendsburg, Rendsburg, Germany.
Artif Organs. 2020 Feb;44(2):162-173. doi: 10.1111/aor.13548. Epub 2019 Oct 20.
Acute kidney injury (AKI) is frequent in patients scheduled for implantation of a left ventricular assist device (LVAD) and associated with increased mortality. Although several risk models for the prediction of postoperative renal replacement therapy (RRT) have been developed for cardiothoracic patients, none of these scoring systems have been validated in LVAD patients. A retrospective, single center analysis of all patients undergoing LVAD implantation between September 2013 and July 2016 was performed. Primary outcome was AKI requiring RRT within 14 days after surgery. The predictive capacity of the Cleveland Clinic Score (CCS), the Society of Thoracic Surgeons Score (STS), and the Simplified Renal Index Score (SRI) were evaluated. 76 patients underwent LVAD implantation, 19 patients were excluded due to preoperative RRT. RRT was associated with a prolonged ventilation time, length of stay on the ICU and 180 day mortality (14(60.9%) vs 6(17.6%), P < .01). Whereas the Thakar Score (7.43 ± 1.75 vs 6.44 ± 1.44, P = .02) and the Mehta Score (28.12 ± 15.08 vs 21.53 ± 5.43, P = .02) were significantly higher in patients with RRT than in those without RRT, the SRI did not differ between these groups (3.96 ± 1.15 vs 3.44 ± 1.05, P = .08). Using ROC analyses, CCS, STS, and SRI showed moderate predictive capacity for RRT with an AUC of 0.661 ± 0.073 (P = .040), 0.637 ± 0.079 (P = .792), and 0.618 ± 0.075 (P = .764), respectively, with comparable accuracy in the Delong test. Using univariate logistic regression analysis, only the De Ritis Ratio (OR 2.67, P = .034) and MELD (OR 1.11, P = .028) were identified as predictors of postoperative RRT. Risk scores which are predictive in general cardiac surgery cannot predict RRT in patients after LVAD implantation. Therefore, it seems to be necessary to develop a specific risk score for this patient population.
急性肾损伤（AKI）在计划植入左心室辅助装置（LVAD）的患者中很常见，且与死亡率增加相关。尽管已经为心胸外科患者开发了几种预测术后肾脏替代治疗（RRT）的风险模型，但这些评分系统均未在LVAD患者中得到验证。对2013年9月至2016年7月期间所有接受LVAD植入的患者进行了一项回顾性单中心分析。主要结局是术后14天内需要RRT的AKI。评估了克利夫兰诊所评分（CCS）、胸外科医师协会评分（STS）和简化肾指数评分（SRI）的预测能力。76例患者接受了LVAD植入，19例患者因术前RRT被排除。RRT与通气时间延长、ICU住院时间延长和180天死亡率相关（14例（60.9%）对6例（17.6%），P <.01）。RRT患者的Thakar评分（7.43±1.75对6.44±1.44，P =.02）和Mehta评分（28.12±15.08对21.53±5.43，P =.02）显著高于无RRT患者，而这些组之间的SRI无差异（3.96±1.15对3.44±1.05，P =.08）。使用ROC分析，CCS、STS和SRI对RRT的预测能力中等，AUC分别为0.661±0.073（P =.040）、0.637±0.079（P =.792）和0.618±0.075（P =.764），在德龙检验中的准确性相当。使用单因素逻辑回归分析，仅德瑞蒂斯比值（OR 2.67，P =.034）和终末期肝病模型（MELD）（OR 1.11，P =.028）被确定为术后RRT的预测因素。一般心脏手术中具有预测性的风险评分不能预测LVAD植入术后患者的RRT。因此，似乎有必要为该患者群体开发一种特定的风险评分。
