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预测非急诊心脏手术后急性肾损伤:术前记分卡。

Predicting acute kidney injury following nonemergent cardiac surgery: A preoperative scorecard.

机构信息

Department of Medicine, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada.

Department of Medicine, Division of Cardiology, King Abdulaziz University, Jeddah, Saudi Arabia.

出版信息

J Card Surg. 2021 Jul;36(7):2204-2212. doi: 10.1111/jocs.15503. Epub 2021 Mar 19.

DOI:10.1111/jocs.15503
PMID:33738864
Abstract

OBJECTIVE

To determine the predictors of postoperative acute kidney injury (AKI) following nonemergent cardiac surgery among patients with variable preoperative estimated glomerular filtration rate (eGFR) levels.

METHODS

A retrospective study of patients who underwent elective or in-hospital cardiac surgical procedures was performed between January 2006 and November 2015. The procedures included isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR), or combined CABG and AVR. The primary outcome AKI (any stage) following nonemergent cardiac surgery utilizing the 2012 Kidney Disease-Improving Global Outcomes (KDIGO) criteria. Patients were categorized based on the following renal outcomes: mild AKI, severe AKI (KDIGO stage 2 or 3), and postoperative dialysis. Patients with G5 preoperative kidney function (including dialysis patients) were excluded.

RESULTS

A total of 6675 patients were included in our study. The mean age was 66.8 years (SD ± 10.4), with 76.3% being males. A total of 4487 patients had normal or mildly decreased eGFR (G1 or G2) preoperatively (67.2%), while 1960 patients were in the G3 category (29.4%). Only 228 patients (3.4%) had G4 renal function. A total of 1453 (21.7%) patients experienced postoperative AKI. The need for postoperative dialysis occurred in 3.2% of the AKI subgroup. In-hospital mortality was higher among the AKI subgroup (7.2% vs. 0.5%; p < .0001). In an adjusted model, a lower preoperative eGFR category was the strongest predictor of AKI. A practical scorecard for the preoperative estimation of severe AKI for nonemergent cardiac procedures incorporating these parameters was developed.

CONCLUSIONS

Preoperative eGFR is the strongest predictor of postoperative AKI in individuals undergoing nonemergent cardiac surgery. A practical scorecard incorporating preoperative predictors of AKI may allow informed decision-making and predict AKI following nonemergent cardiac surgery.

摘要

目的

确定不同术前估算肾小球滤过率(eGFR)水平的非紧急心脏手术后急性肾损伤(AKI)的预测因素。

方法

对 2006 年 1 月至 2015 年 11 月间接受择期或院内心脏外科手术的患者进行了回顾性研究。手术包括单纯冠状动脉旁路移植术(CABG)、单纯主动脉瓣置换术(AVR)或 CABG 和 AVR 联合手术。主要结局是利用 2012 年肾脏疾病-改善全球预后(KDIGO)标准,确定非紧急心脏手术后 AKI(任何阶段)。根据以下肾脏结局对患者进行分类:轻度 AKI、重度 AKI(KDIGO 分期 2 或 3 期)和术后透析。排除术前肾功能 G5(包括透析患者)的患者。

结果

本研究共纳入 6675 例患者。患者平均年龄为 66.8 岁(标准差±10.4),76.3%为男性。术前 eGFR 正常或轻度降低(G1 或 G2)的患者有 4487 例(67.2%),G3 患者有 1960 例(29.4%)。只有 228 例(3.4%)患者肾功能为 G4。术后 AKI 患者有 1453 例(21.7%)。AKI 亚组中有 3.2%的患者需要术后透析。AKI 亚组的院内死亡率较高(7.2%比 0.5%;p<0.0001)。在调整后的模型中,术前 eGFR 分类是 AKI 的最强预测因素。针对非紧急心脏手术,我们开发了一个包含这些参数的术前严重 AKI 预测因素的实用评分卡。

结论

术前 eGFR 是个体接受非紧急心脏手术后发生术后 AKI 的最强预测因素。包含 AKI 术前预测因素的实用评分卡可有助于做出明智的决策,并预测非紧急心脏手术后 AKI 的发生。

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