Department of Intensive Care Unit, The Third People's Hospital of Bengbu, Bengbu, Anhui Province, China.
Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China.
Heart Surg Forum. 2021 Mar 25;24(2):E282-E292. doi: 10.1532/hsf.3537.
Acute kidney injury (AKI) is a common complication of cardiovascular surgery. The aim of this study was to investigate the correlation between Vasoactive-Inotropic Score (VIS) and postoperative acute kidney injury in adult patients with cardiovascular surgery.
We retrospectively reviewed the data of 1935 adult patients who underwent cardiovascular surgery between September 2017 and May 2019. The data of patients included demographic data, laboratory findings, intraoperative details, and postoperative clinical outcomes. We calculated VIS-max by using the highest doses of vasoactive and inotropic medications during the first 24h after cardiovascular surgery. Logistic regression model was used to evaluate whether the VIS-max was independently associated with postoperative AKI. Additionally, improvements in risk reclassification and discrimination were evaluated by calculating the net reclassification improvement (NRI), C-index and the integrated discrimination improvement (IDI) with the addition of the VIS-max to a baseline model of the Society of Thoracic Surgeons (STS) score for analyzing the association of VIS-max with postoperative AKI.
In 1935 patients, 291 patients (15.0%) developed postoperative AKI from the second to seventh day after cardiovascular surgery, and 30 patients (1.6%) needed renal replacement therapy (RRT). In 291 patients with AKI, 3 patients (0.2%) with AKI class 1, 12 patients (0.6%) with AKI class 2, and 15 patients (0.8%) with AKI class 3 needed RRT. Multivariate logistic regression analysis showed that VIS-max was associated with postoperative AKI (odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.11-1.34, P < 0.001) and the need for RRT in AKI patients (OR: 1.29, 95%CI: 1.01-1.83, P = 0.007). The area under the ROC curves (AUROC) of VIS-max combining STS score for predicting postoperative AKI (AUROC: 0.84, 95%CI: 0.81-0.87, P < 0.001) and need of RRT (AUROC: 0.91, 95%CI: 0.86-0.96, P < 0.001) significantly were higher than the AUC of VIS-max, STS score and EuroSCORE. Inclusion of VIS-max into basic risk model of STS score provided an increase in all indexes of prognostic accuracy for postoperative AKI and need of RRT: C-statistic: 0.721, NRI: 21.8%, IDI: 4.9%; and C-statistic: 0.745, NRI: 24.7%, IDI: 5.6%, respectively.
VIS-max is an independent predictor of postoperative AKI in adult patients after cardiovascular surgery and increases prognostic accuracy of STS score, allowing a risk reclassification.
急性肾损伤（AKI）是心血管手术的常见并发症。本研究旨在探讨心血管手术后成人患者血管活性-正性肌力药物评分（VIS）与术后急性肾损伤之间的相关性。
我们回顾性分析了 2017 年 9 月至 2019 年 5 月期间接受心血管手术的 1935 名成年患者的数据。患者数据包括人口统计学数据、实验室检查结果、术中细节和术后临床结局。我们通过计算心血管手术后 24 小时内使用的血管活性和正性肌力药物的最高剂量来计算 VIS-max。使用逻辑回归模型评估 VIS-max 是否与术后 AKI 独立相关。此外，通过计算净重新分类改善（NRI）、C 指数和综合判别改善（IDI），评估了添加 VIS-max 对胸外科医生协会（STS）评分基线模型的风险重新分类和判别改善，以分析 VIS-max 与术后 AKI 的相关性。
在 1935 名患者中，有 291 名（15.0%）患者在心血管手术后第 2 至第 7 天发生术后 AKI，有 30 名（1.6%）患者需要肾脏替代治疗（RRT）。在 291 名 AKI 患者中，有 3 名（0.2%）AKI 1 级、12 名（0.6%）AKI 2 级和 15 名（0.8%）AKI 3 级需要 RRT。多变量逻辑回归分析显示，VIS-max 与术后 AKI（比值比 [OR]：1.19，95%置信区间 [CI]：1.11-1.34，P<0.001）和 AKI 患者的 RRT 需求（OR：1.29，95%CI：1.01-1.83，P=0.007）相关。VIS-max 结合 STS 评分预测术后 AKI（AUROC：0.84，95%CI：0.81-0.87，P<0.001）和 RRT 需求（AUROC：0.91，95%CI：0.86-0.96，P<0.001）的 ROC 曲线下面积（AUROC）明显高于 VIS-max、STS 评分和 EuroSCORE。将 VIS-max 纳入 STS 评分的基本风险模型可提高术后 AKI 和 RRT 需求的所有预后准确性指标：C 统计量：0.721，NRI：21.8%，IDI：4.9%；和 C 统计量：0.745，NRI：24.7%，IDI：5.6%，分别。
VIS-max 是心血管手术后成人患者术后 AKI 的独立预测因子，并提高了 STS 评分的预后准确性，实现了风险再分类。
