Department of Critical Care Medicine, The Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, Pa.
Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.
J Thorac Cardiovasc Surg. 2021 Jul;162(1):143-151.e7. doi: 10.1016/j.jtcvs.2019.11.137. Epub 2020 Jan 9.
Oliguria after cardiac surgery remains of uncertain clinical significance. Therefore, we investigated the relationship of acute kidney injury severity across urine output and creatinine domains with the risk for major adverse kidney events at 180 days. We aimed to determine the impact of acute kidney injury after cardiac surgery.
In a retrospective multicenter study, we investigated the relationship of acute kidney injury severity across urine output and creatinine categories with the risk for major adverse kidney events at 180 days-the composite of death, dialysis, and persistent renal dysfunction-using a large database of patients undergoing cardiac surgery at 1 of 5 hospitals within the regional medical system. We analyzed electronic records from 6637 patients treated between 2008 and 2014, of whom 5389 (81.2%) developed any acute kidney injury within 72 hours of surgery. We stratified patients by levels of urine output or serum creatinine according to Kidney Disease Improving Global Outcomes criteria for acute kidney injury.
Major adverse kidney events at 180 days increased from 4.5% for no acute kidney injury to 61.3% for stage 3 acute kidney injury (P < .001). Death or dialysis by day 180 was 2.4% for those with no acute kidney injury and 46.7% for those with acute kidney injury stage 3 (P < .001). Isolated oliguria was common (42.6%), and isolated azotemia was rare (6.1%). Even stage 1 acute kidney injury by oliguria alone was associated with an increased risk of major adverse kidney events at 180 days (odds ratio, 1.76; 1.20-2.57; P = .004), mainly driven by persistent renal dysfunction (odds ratio, 2.01; 1.26-3.18; P = .003).
Acute kidney injury is common in patients undergoing cardiac surgery, and even milder forms of acute kidney injury, including isolated stage 1 oliguria, are associated with adverse long-term consequences.
心脏手术后少尿的临床意义仍不确定。因此，我们研究了急性肾损伤严重程度在尿量和肌酐两个方面与术后 180 天主要不良肾脏事件风险的关系。我们旨在确定心脏手术后急性肾损伤的影响。
在一项回顾性多中心研究中，我们研究了根据急性肾损伤严重程度在尿量和肌酐两个方面进行分层，与术后 180 天主要不良肾脏事件（复合终点为死亡、透析和持续性肾功能障碍）的关系，该研究纳入了在区域医疗系统内的 5 家医院中的 1 家接受心脏手术的患者的大型数据库。我们分析了 6637 名患者的电子记录，这些患者在 2008 年至 2014 年间接受了治疗，其中 5389 名（81.2%）患者在术后 72 小时内出现任何急性肾损伤。根据急性肾损伤改善全球结局（KDIGO）标准，我们根据尿量或血清肌酐水平将患者分为不同的水平。
术后 180 天的主要不良肾脏事件发生率从无急性肾损伤的 4.5%增加到 3 期急性肾损伤的 61.3%（P<0.001）。到第 180 天死亡或透析的发生率为无急性肾损伤的 2.4%，而急性肾损伤 3 期的 46.7%（P<0.001）。孤立性少尿很常见（42.6%），孤立性氮质血症很少见（6.1%）。即使是单独由少尿引起的 1 期急性肾损伤也与术后 180 天主要不良肾脏事件的风险增加相关（优势比，1.76；1.20-2.57；P=0.004），主要是由持续性肾功能障碍引起的（优势比，2.01；1.26-3.18；P=0.003）。
心脏手术后患者中急性肾损伤很常见，即使是更轻微的急性肾损伤，包括孤立性 1 期少尿，也与不良的长期后果相关。
