Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2020 Nov;64(10):1397-1404. doi: 10.1111/aas.13664. Epub 2020 Jul 14.
Acute kidney injury (AKI) is a serious complication following cardiac surgery associated with increased mortality. Red blood cell transfusion enhances the risk of developing AKI. However, the impact of other blood products on AKI is virtually unexplored. The aim of this study was to explore if transfusion of red blood cells, fresh frozen plasma and platelets alone or in combination were associated with postoperative AKI.
Patients undergoing elective on-pump cardiac surgery were included (n = 1960) between 2012 to 2014. Transfusion data were collected intraoperatively and until the first postoperative day. AKI was classified according to the KDIGO criteria. Data were analysed using univariate and stepwise multiple logistic regression with adjustment for clinical risk factors and complementary blood products.
AKI was observed in 542 patients (27.7%). In univariate analysis and following adjustment for clinical risk factors, administration of red blood cells, freshfrozen plasma and platelets were all independently associated with KDIGO stage 2-3. Following additional adjustment for complementary blood products, only red blood cell transfusion remained significantly associated with AKI. A dose-dependent association between volume of red blood cells and degree of AKI severity was observed.
Transfusion of all blood products in a dose-dependent manner increased the risk for AKI. However, in multivariate analysis combining all blood products, only red blood cell transfusion remained significantly associated with AKI development.
急性肾损伤（AKI）是心脏手术后的一种严重并发症，与死亡率增加有关。红细胞输注会增加发生 AKI 的风险。然而，其他血液制品对 AKI 的影响几乎没有被探索过。本研究旨在探讨单独或联合输注红细胞、新鲜冰冻血浆和血小板是否与术后 AKI 相关。
纳入 2012 年至 2014 年期间接受体外循环心脏手术的择期患者（n=1960）。术中及术后第 1 天收集输血数据。根据 KDIGO 标准对 AKI 进行分类。使用单变量和逐步多变量逻辑回归分析，对临床危险因素和补充血液制品进行调整。
542 例患者（27.7%）发生 AKI。在单变量分析和临床危险因素调整后，输注红细胞、新鲜冰冻血浆和血小板均与 KDIGO 2-3 期 AKI 独立相关。在进一步调整补充血液制品后，只有红细胞输注与 AKI 仍显著相关。观察到红细胞输注量与 AKI 严重程度之间存在剂量依赖性关系。
以剂量依赖的方式输注所有血液制品会增加 AKI 的风险。然而，在结合所有血液制品的多变量分析中，只有红细胞输注与 AKI 发生显著相关。
