Dong Ning, Piao Hulin, Du Yu, Li Bo, Xu Jian, Wei Shibo, Liu Kexiang
Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China.
Department of Emergency Medicine, First Hospital of Bethune, Jilin University, Changchun, China.
Interact Cardiovasc Thorac Surg. 2020 May 1;30(5):746-753. doi: 10.1093/icvts/ivaa011.
Acute kidney injury (AKI) is a common complication of cardiovascular surgery that is associated with increased mortality, especially after surgeries involving the aorta. Early detection and prevention of AKI in patients with aortic dissection may help improve outcomes. The objective of this study was to develop a practical prediction score for AKI after surgery for Stanford type A acute aortic dissection (TAAAD).
This was a retrospective cohort study that included 2 independent hospitals. A larger cohort of 326 patients from The Second Hospital of Jilin University was used to identify the risk factors for AKI and to develop a risk score. The derived risk score was externally validated in a separate cohort of 102 patients from the other hospital.
The scoring system included the following variables: (i) age >45 years; (ii) body mass index >25 kg/m2; (iii) white blood cell count >13.5 × 109/l; and (iv) lowest perioperative haemoglobin <100 g/l, cardiopulmonary bypass duration >150 min and renal malperfusion. On receiver operating characteristic curve analysis, the score predicted AKI with fair accuracy in both the derivation [area under the curve 0.778, 95% confidence interval (CI) 0.726-0.83] and the validation (area under the curve 0.747, 95% CI 0.657-0.838) cohorts.
We developed a convenient scoring system to identify patients at high risk of developing AKI after surgery for TAAAD. This scoring system may help identify patients who require more intensive postoperative management and facilitate appropriate interventions to prevent AKI and improve patient outcomes.
急性肾损伤（AKI）是心血管手术常见的并发症，与死亡率增加相关，尤其是在涉及主动脉的手术后。早期发现和预防主动脉夹层患者的AKI可能有助于改善预后。本研究的目的是为斯坦福A型急性主动脉夹层（TAAAD）手术后的AKI制定一个实用的预测评分。
这是一项回顾性队列研究，纳入了2家独立医院。来自吉林大学第二医院的326例患者组成的较大队列用于确定AKI的危险因素并制定风险评分。在来自另一家医院的102例患者的独立队列中对得出的风险评分进行外部验证。
评分系统包括以下变量：（i）年龄>45岁；（ii）体重指数>25 kg/m²；（iii）白细胞计数>13.5×10⁹/L；（iv）围手术期最低血红蛋白<100 g/L、体外循环时间>150分钟和肾脏灌注不良。在受试者工作特征曲线分析中，该评分在推导队列[曲线下面积0.778，95%置信区间（CI）0.726 - 0.83]和验证队列[曲线下面积0.747，95%CI 0.657 - 0.838]中对AKI的预测准确性均尚可。
我们开发了一种简便的评分系统，以识别TAAAD手术后发生AKI的高危患者。该评分系统可能有助于识别需要更强化术后管理的患者，并促进采取适当干预措施预防AKI并改善患者预后。
