术前他汀类药物治疗对老年瓣膜置换手术患者急性肾损伤的影响。
The effect of preoperative statin treatment on acute kidney injury in elderly patients undergoing valve replacement surgery.
作者信息
Fu Bing-Qi, Wei Xue-Biao, Su Zedazhong, Lin Ying-Wen, Ke Zu-Hui, Tan Tong, Chen Ji-Yan, Wang Shou-Hong, Yu Dan-Qing
机构信息
Division of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
Division of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
出版信息
Eur J Clin Pharmacol. 2022 Mar;78(3):505-512. doi: 10.1007/s00228-021-03252-4. Epub 2021 Nov 23.
PURPOSES
The effects of preoperative statin treatment on acute kidney injury (AKI) remain controversial, and current clinical evidence regarding statin use in the elderly undergoing valve replacement surgery (VRS) is insufficient. The present study aimed to investigate the association between preoperative statin treatment and AKI after VRS in the elderly.
METHODS
Three thousand seven hundred ninety-one elderly patients (≥ 60 years) undergoing VRS were included in this study and divided into 2 groups, according to the receipt of statin treatment before the operation: statin users (n = 894) and non-users (n = 2897). We determined the associations between statin use, AKI, and other adverse events using a multivariate model and propensity score-matched analysis.
RESULTS
After propensity score-matched analysis, there was no difference between statin users and non-users in regard to postoperative AKI (72.5% vs. 72.4%, p = 0.954), in-hospital death (5.7% vs. 5.1%, p = 0.650) and 1-year mortality (log-rank = 0, p = 0.986). The multivariate analysis showed that statin use was not an independent risk factor for postoperative AKI (OR = 0.97, 95% CI: 0.90-1.17, p = 0.733), in-hospital mortality (OR = 1.12, 95% CI: 0.75-1.68, p = 0.568), or 1-year mortality (HR = 0.95, 95% CI: 0.70-1.28, p = 0.715).
CONCLUSION
Preoperative statin treatment did not significantly affect the risk of AKI among elderly patients undergoing VRS.
目的
术前他汀类药物治疗对急性肾损伤（AKI）的影响仍存在争议，目前关于他汀类药物在接受瓣膜置换手术（VRS）的老年患者中使用的临床证据不足。本研究旨在探讨术前他汀类药物治疗与老年患者VRS术后AKI之间的关联。
方法
本研究纳入了3791例接受VRS的老年患者（≥60岁），并根据术前是否接受他汀类药物治疗分为两组：他汀类药物使用者（n = 894）和非使用者（n = 2897）。我们使用多变量模型和倾向评分匹配分析来确定他汀类药物使用、AKI和其他不良事件之间的关联。
结果
经过倾向评分匹配分析，他汀类药物使用者和非使用者在术后AKI（72.5%对72.4%，p = 0.954）、住院死亡（5.7%对5.1%，p = 0.650）和1年死亡率（对数秩= 0，p = 0.986）方面没有差异。多变量分析显示，他汀类药物使用不是术后AKI（OR = 0.97，95% CI：0.90 - 1.17，p = 0.733）、住院死亡率（OR = 1.12，95% CI：0.75 - 1.68，p = 0.568）或1年死亡率（HR = 0.95，95% CI：0.70 - 1.28，p = 0.715）的独立危险因素。
结论
术前他汀类药物治疗对接受VRS的老年患者发生AKI的风险没有显著影响。
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