Wang Rui, Wang Xian, Zhu Yifan, Chen Wen, Li Liangpeng, Chen Xin
Department of Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, 68 Changle Rd, Nanjing, 210006, People's Republic of China.
Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 321 Zhongshan Rd, Nanjing, 210008, People's Republic of China.
J Cardiothorac Surg. 2020 Jul 24;15(1):186. doi: 10.1186/s13019-020-01226-8.
This single-centre, retrospective propensity score matching (PSM) study designed to study the impact of cardiopulmonary bypass (CPB) on postoperative acute kidney injury (AKI) and the relationship between AKI and long-term outcomes in elderly patients undergoing coronary artery bypass grafting (CABG).
After PSM, 466 pairs of patients (A group, on-pump; B group, off-pump) who were aged≥70 years undergoing first isolated CABG surgery from January 2012 to December 2016 entered the study. AKI was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria. The incidence and severity of in-hospital AKI were compared. The impacts of AKI on the long-term outcomes including new onset of dialysis and mortality were analyzed.
The two PSM groups had similar baseline and procedure except whether the CPB was used or not. In hospital and 30-day mortality was of no difference(χ2 = 0.051, p = 0.821). AKI of any severity occurred in 40.3% of all patients, with stage 1 accounting for most cases. No difference regarding the incidence and severity of AKI could be found: AKIN stage 1: 139 (29.8%) vs 131 (28.1%); AKIN stage 2: 40 (8.6%) vs 35 (7.5%); AKIN stage 3: 18 (3.9%) vs 13 (2.8%), (u = 0.543, p = 0.532). No difference was observed in the in-hospital new onset of dialysis (χ2 = 0.312, P = 0.576). The use of CPB was not found to influence long-term new onset of dialysis (χ2 = 0.14, p = 0.708) and mortality (χ2 = 0.099, p = 0.753). Comparing with non-AKI patients, AKI patients were associated with an increased rates of new onset of dialysis (χ2 = 8.153, p = 0.004) and mortality (χ2 = 6.277, p = 0.012) during the follow-up. Multivariable logistic regression manifested that the HR for long-term new onset of dialysis and mortality in AKI patients vs. non-AKI patients was 1.83 and 1.31 respectively (95%CI 1.12-2.86, p = 0.007; 95%CI 1.17-2.58, p = 0.015). The HR for long-term new onset of dialysis and mortality in on-pump group vs. off-pump group was 1.07 and 1.11 respectively (95%CI 1.03-1.23, p = 0.661; 95%CI 1.09-1.64, p = 0.702).
For elderly CABG patients, AKI was common, but deterioration of dialysis was a seldom incidence. Comparing with on-pump, off-pump did not decrease the rates or severity of AKI, long-term new onset of dialysis or mortality. AKI was associated with an increased long-term new onset of dialysis and decreased long-term survival.
本单中心回顾性倾向评分匹配（PSM）研究旨在探讨体外循环（CPB）对老年冠状动脉旁路移植术（CABG）患者术后急性肾损伤（AKI）的影响以及AKI与长期预后的关系。
通过PSM，466对年龄≥70岁、于2012年1月至2016年12月期间首次接受单纯CABG手术的患者（A组，体外循环组；B组，非体外循环组）进入研究。根据急性肾损伤网络（AKIN）标准定义并分类AKI。比较院内AKI的发生率和严重程度。分析AKI对包括新透析开始和死亡率在内的长期预后的影响。
除是否使用CPB外，两个PSM组的基线和手术情况相似。住院期间和30天死亡率无差异（χ2 = 0.051，p = 0.821）。所有患者中任何严重程度的AKI发生率为40.3%，其中1期占大多数病例。AKI的发生率和严重程度无差异：AKIN 1期：139例（29.8%）对131例（28.1%）；AKIN 2期：40例（8.6%）对35例（7.5%）；AKIN 3期：18例（3.9%）对13例（2.8%），（u = 0.543，p = 0.532）。院内新透析开始情况无差异（χ2 = 0.312，P = 0.576）。未发现使用CPB会影响长期新透析开始情况（χ2 = 0.14，p = 0.708）和死亡率（χ2 = 0.099，p = 0.753）。与非AKI患者相比，AKI患者在随访期间新透析开始率（χ2 = 8.153，p = 0.004）和死亡率（χ2 = 6.277，p = 0.012）增加。多变量逻辑回归显示，AKI患者与非AKI患者相比，长期新透析开始和死亡率的HR分别为1.83和1.31（95%CI 1.12 - 2.86，p = 0.007；95%CI 1.17 - 2.58，p = 0.015）。体外循环组与非体外循环组相比，长期新透析开始和死亡率的HR分别为1.07和1.11（95%CI 1.03 - 1.23，p = 0.661；95%CI 1.09 - 1.64，p = 0.702）。
对于老年CABG患者，AKI常见，但透析恶化很少见。与体外循环相比，非体外循环并未降低AKI的发生率或严重程度、长期新透析开始率或死亡率。AKI与长期新透析开始增加和长期生存率降低相关。
