Department of Nephrology, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1, Shangcheng Road, Yiwu, China.
Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; The Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, 79, Qingchun Road, Hangzhou, China.
Sci Rep. 2020 Apr 14;10(1):6403. doi: 10.1038/s41598-020-63522-6.
Acute kidney injury (AKI) after open cardiac surgery is associated with a longer hospital stay and higher risk of mortality. We aimed to explore the association between preoperative serum fibrinogen level and risk of postoperative AKI in patients with open cardiac surgery. 3459 patients who underwent cardiac valve replacement surgery from January 2011 to September 2015 were recruited. The primary outcome was AKI, defined as AKI stage-1 or higher based on the Kidney Disease: Improving Global Outcomes (KDIGO) Guidelines. Synthetic Minority Oversampling Technique (SMOTE) was used to subsample minority groups to eliminate classification bias. 510 (14.74%) patients developed postoperative AKI. Serum fibrinogen was independently associated with AKI (OR = 1.211, 95% CI 1.080 to 1.358, p = 0.001) after adjustment of covariates. The receiver operator characteristic (ROC) curve for the outcome of AKI, after the addition of serum fibrinogen, had a c-statistic increasing from 0.72 to 0.73 (p < 0.001). This translated to a substantially improved AKI risk classification with a net reclassification index of 0.178 (p < 0.001). After SMOTE subsampling, serum fibrinogen was still independently associated with AKI grade 1 or higher (OR = 1.212, 95% CI 1.1089 to 1.347, p = 0.003). Preoperative serum fibrinogen levels were associated with the risk of postoperative AKI after cardiac valve replacement surgery.
体外循环心脏手术后急性肾损伤（AKI）与住院时间延长和死亡率升高相关。本研究旨在探讨体外循环心脏手术后患者术前血清纤维蛋白原水平与术后 AKI 风险的关系。2011 年 1 月至 2015 年 9 月，我们招募了 3459 例行心脏瓣膜置换术的患者。主要结局为 AKI，根据肾脏疾病：改善全球预后（KDIGO）指南定义为 AKI 1 期或更高。采用合成少数过采样技术（SMOTE）对少数群体进行亚采样以消除分类偏差。510（14.74%）例患者发生术后 AKI。校正协变量后，血清纤维蛋白原与 AKI 独立相关（OR=1.211，95%CI 1.080 至 1.358，p=0.001）。在加入血清纤维蛋白原后，AKI 结局的受试者工作特征（ROC）曲线的 C 统计量从 0.72 增加到 0.73（p<0.001）。这意味着 AKI 风险分类有了实质性的改善，净重新分类指数为 0.178（p<0.001）。SMOTE 亚采样后，血清纤维蛋白原仍与 AKI 1 级或更高独立相关（OR=1.212，95%CI 1.1089 至 1.347，p=0.003）。体外循环心脏手术后，术前血清纤维蛋白原水平与术后 AKI 风险相关。
