Abbas Sakina, Qayum Ihtisham, Wahid Rabiya, Salman Fnu, Khan Henna, Hassan Fatima, Babar Anum, Inayat Arslan
Medicine, Dow University of Health Sciences, Karachi, PAK.
Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK.
Cureus. 2021 May 21;13(5):e15154. doi: 10.7759/cureus.15154.
Introduction Transcatheter aortic valve replacement (TAVR) has been established as a standard of care for patients with severe aortic stenosis. We aim to study the predictors of acute kidney injury (AKI) after TAVR from a contemporary analysis using the National Inpatient Sample (NIS) database. Methods We performed a national analysis using the NIS database to evaluate predictors of acute kidney injury (AKI) after TAVR. Our study period was from 2015 to 2018, and we identified TAVR patients in all procedure fields. Patients aged less than 18 years were excluded from the study. Results We report data of 173,760 TAVR patients, of which 20,045 (11.5%) had AKI and 153,715 (88.4%) did not. There were three principal findings of our study. First, mortality was higher in patients with AKI compared to patients who did not have AKI (8% vs. 0.8%; p<0.01). Second, patients with chronic kidney disease, weight loss, liver disease, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, metastatic cancer, and peripheral vascular disease had higher adjusted odds of AKI. Third, length of stay and cost of stay were significantly higher in patients who had AKI during the index admission. Conclusion Patients with AKI had higher in-hospital mortality. We also report that at baseline, chronic kidney disease, weight loss, liver disease, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, metastatic cancer, and peripheral vascular disease were important predictors of AKI in patients after TAVR. Length of stay and cost of stay were higher with AKI, which result in higher burden on the health care system due to increased resource utilization.
引言 经导管主动脉瓣置换术（TAVR）已成为重度主动脉瓣狭窄患者的标准治疗方法。我们旨在通过使用全国住院患者样本（NIS）数据库进行当代分析，研究TAVR术后急性肾损伤（AKI）的预测因素。方法 我们使用NIS数据库进行全国性分析，以评估TAVR术后急性肾损伤（AKI）的预测因素。我们的研究时间段为2015年至2018年，我们在所有手术领域中识别TAVR患者。年龄小于18岁的患者被排除在研究之外。结果 我们报告了173,760例TAVR患者的数据，其中20,045例（11.5%）发生了AKI，153,715例（88.4%）未发生AKI。我们的研究有三个主要发现。第一，与未发生AKI的患者相比，发生AKI的患者死亡率更高（8%对0.8%；p<0.01）。第二，患有慢性肾脏病、体重减轻、肝病、充血性心力衰竭、脑血管疾病、慢性阻塞性肺疾病、转移性癌症和外周血管疾病的患者发生AKI的校正比值更高。第三，在索引住院期间发生AKI的患者住院时间和住院费用显著更高。结论 发生AKI的患者住院死亡率更高。我们还报告，在基线时，慢性肾脏病、体重减轻、肝病、充血性心力衰竭、脑血管疾病、慢性阻塞性肺疾病、转移性癌症和外周血管疾病是TAVR术后患者发生AKI的重要预测因素。AKI患者的住院时间和住院费用更高，由于资源利用增加，这给医疗保健系统带来了更高的负担。
