Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
Shanghai Medical Center of Kidney, No. 180 Fenglin Road, Shanghai, 200032, China.
Clin Exp Nephrol. 2020 Sep;24(9):798-805. doi: 10.1007/s10157-020-01908-6. Epub 2020 Jun 3.
Delayed diagnosis of acute kidney injury (AKI) is common because the changes in renal function markers often lag injury. We aimed to find optimal non-invasive hemodynamic variables for the prediction of postoperative AKI and AKI renal replacement therapy (RRT).
The data were collected from 1,180 patients who underwent cardiac surgery in our hospital between March 2015 and Feb 2016. Postoperative central venous pressure (CVP), mean arterial pressure (MAP), heart rate, PaO, and PaCO on ICU admission and daily fluid input and output (calculated as 24 h PFO) were monitored and compared between AKI vs. non-AKI and RRT vs non-RRT cases.
The AKI and AKI-RRT incidences were 36.7% (n = 433) and 1.2% (n = 14). Low cardiac output syndromes (LCOSs) occurred significantly more in AKI and RRT than in non-AKI or non-RRT groups (13.2% vs. 3.9%, P < 0.01; 42.9% vs. 7.1%, P < 0.01). CVP on ICU admission was significantly higher in AKI and RRT than in non-AKI and non-RRT groups (11.5 vs. 9.0 mmHg, P < 0.01; 13.3 vs. 9.9 mmHg, P < 0.01). 24 h PFO in AKI and RRT cases were significantly higher than in non-AKI or non-RRT patients (1.6% vs. 0.9%, P < 0.01; 3.9% vs. 0.8%, P < 0.01). The areas under the ROC curves to predict postoperative AKI by CVP on ICU admission (> 11 mmHg) + LCOS + 24 h PFO (> 5%) and to predict AKI-RRT by CVP on ICU admission (> 13 mmHg) + LCOS + 24 h PFO (> 5%) were 0.763 and 0.886, respectively.
The volume-associated hemodynamic variables, including CVP on ICU admission, LCOS, and 24 h PFO after surgery could predict postoperative AKI and AKI-RRT.
急性肾损伤（AKI）的诊断常常被延误，因为肾功能标志物的变化通常滞后于损伤。我们旨在寻找最佳的非侵入性血流动力学变量，以预测术后 AKI 和 AKI 肾脏替代治疗（RRT）。
本研究数据来自于 2015 年 3 月至 2016 年 2 月期间在我院接受心脏手术的 1180 名患者。比较 AKI 与非 AKI 组、RRT 与非 RRT 组患者 ICU 入科时的中心静脉压（CVP）、平均动脉压（MAP）、心率、PaO 和 PaCO，以及术后每日液体输入量和输出量（计算为 24 h 净液体输出量，即 PFO）。
AKI 和 AKI-RRT 的发生率分别为 36.7%（n=433）和 1.2%（n=14）。AKI 和 RRT 患者的低心输出综合征（LCOS）发生率明显高于非 AKI 或非 RRT 组（13.2% vs. 3.9%，P<0.01；42.9% vs. 7.1%，P<0.01）。AKI 和 RRT 患者 ICU 入科时的 CVP 明显高于非 AKI 和非 RRT 组（11.5 vs. 9.0 mmHg，P<0.01；13.3 vs. 9.9 mmHg，P<0.01）。AKI 和 RRT 患者的 24 h PFO 明显高于非 AKI 或非 RRT 患者（1.6% vs. 0.9%，P<0.01；3.9% vs. 0.8%，P<0.01）。ICU 入科时 CVP（>11mmHg）+LCOS+术后 24 h PFO（>5%）预测术后 AKI，以及 ICU 入科时 CVP（>13mmHg）+LCOS+术后 24 h PFO（>5%）预测 AKI-RRT 的 ROC 曲线下面积分别为 0.763 和 0.886。
包括 ICU 入科时 CVP、LCOS 和术后 24 h PFO 在内的与容量相关的血流动力学变量可预测术后 AKI 和 AKI-RRT。
