Department of Anesthesiology and Intensive Care, University of Turku, Turku, Finland; Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
Department of Anesthesiology and Intensive Care, University of Turku, Turku, Finland; Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
J Cardiothorac Vasc Anesth. 2020 Dec;34(12):3329-3335. doi: 10.1053/j.jvca.2020.04.055. Epub 2020 May 14.
Acute kidney injury requiring renal replacement therapy after cardiac surgery has an incidence of 2% to 15%, and mortality in affected patients approximates 50%. The authors aimed to study the determinants of poor prognosis in patients receiving continuous renal replacement therapy (CRRT) after cardiac surgery.
Retrospective, observational single-center study.
Tertiary care, university hospital.
Cardiac surgery patients admitted to the intensive care unit (ICU) needing postoperative CRRT between January 1, 2010, and September 31, 2019.
Predictors of mortality were examined using groupwide comparisons between ICU survivors versus nonsurvivors and univariate and multivariate Cox proportional hazards models.
During the study period, 67 cardiac surgery patients without prior maintenance dialysis required CRRT postoperatively. ICU mortality was 47.7% and 90-day mortality was 58.2%. Only 37.3% of patients were alive at 1 year after surgery. Blood lactate at the start of dialysis was the most significant predictor of ICU and overall mortality. Eighty-seven percent of patients with lactate >3 mmol/L died in the ICU compared with 27.3% of patients with lactate ≤3 mmol/L (p < 0.0001). In patients with lactate exceeding 5.3 mmol/L, ICU mortality was 100%. In a stepwise multivariate Cox proportional hazards model, the association with mortality remained significant for lactate at the start of CRRT (per 1 mmol/L, hazard ratio [HR] 1.19 [95% confidence interval {CI} 1.11-1.28], p < 0.0001), troponin T on the first postoperative morning (per 0.1 µg/L, HR 1.004 [95% CI 1.001-1.008], p = 0.01), and 72-hour fluid balance (per 1000 mL, HR 1.12 [95% CI 1.04-1.21], p = 0.005).
Blood lactate at the start of dialysis was the most significant predictor of ICU and overall mortality in patients with CRRT after cardiac surgery.
心脏手术后需要肾脏替代治疗的急性肾损伤的发生率为 2%至 15%，受影响患者的死亡率约为 50%。作者旨在研究心脏手术后接受连续肾脏替代治疗（CRRT）的患者预后不良的决定因素。
回顾性、观察性单中心研究。
三级保健、大学医院。
2010 年 1 月 1 日至 2019 年 9 月 31 日，心脏手术后入住重症监护病房（ICU）需要术后 CRRT 的心脏手术患者。
使用 ICU 幸存者与非幸存者之间的全组比较以及单变量和多变量 Cox 比例风险模型检查死亡率的预测因素。
在研究期间，67 名无术前维持性透析的心脏手术患者术后需要 CRRT。ICU 死亡率为 47.7%，90 天死亡率为 58.2%。手术后 1 年仅有 37.3%的患者存活。透析开始时的血乳酸是 ICU 和总体死亡率的最显著预测因子。87%的乳酸>3mmol/L的患者在 ICU 死亡，而乳酸≤3mmol/L的患者为 27.3%（p<0.0001）。在乳酸>5.3mmol/L的患者中，ICU 死亡率为 100%。在逐步多变量 Cox 比例风险模型中，CRRT 开始时的乳酸与死亡率的关联仍然显著（每 1mmol/L，风险比[HR]1.19[95%置信区间{CI}1.11-1.28]，p<0.0001），术后第 1 天清晨的肌钙蛋白 T（每 0.1μg/L，HR 1.004[95%CI 1.001-1.008]，p=0.01）和 72 小时液体平衡（每 1000mL，HR 1.12[95%CI 1.04-1.21]，p=0.005）。
心脏手术后接受 CRRT 的患者，透析开始时的血乳酸是 ICU 和总体死亡率的最显著预测因子。
