Chen Lu, He Yan, Song Kai, Zhang Bingqian, Liu Lin
Department of Clinical Trials Centre, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
Front Cardiovasc Med. 2022 Jan 27;8:712229. doi: 10.3389/fcvm.2021.712229. eCollection 2021.
It has been reported that poor renal function before surgery is related to poor prognosis. However, there is no specific discussion on the ideal value of preoperative creatinine clearance. Consequently, our primary goal is to explore the correlation between baseline creatinine clearance and short-term mortality after cardiac surgery.
We conducted a secondary data analysis based on a French cardiac surgery cohort. The cohort included 6,889 participants in a Paris university hospital from December 2005 to December 2012. The exposure variable and outcome variable used in this secondary analysis were the preoperative creatinine clearance rate and postoperative hospital mortality. Multivariate logistic regression and generalized additive models were employed.
The nonlinear relationship between the preoperative creatinine clearance rate and postoperative death was observed in this study. The preoperative creatinine clearance rate was negatively correlated with postoperative mortality in the range of 8.9-78.5 in patients younger than 80 years old (odds ratio = 0.98, 95% confidence interval 0.97-0.98, in Cockcroft Gault formulae). However, this effect characteristics reaches saturation after the preoperative creatinine clearance rate exceeds 78.5 (odds ratio = 0.99, 95% confidence interval 0.98-1.00, CG). In patients with history of thromboembolic event and coronary artery disease, the saturation effect were 30.8 mL.min (CG) and 56.6 mL.min(CG).
In the range of 8.9-78.5 (Cockcroft), an increase in preoperative creatinine clearance is associated with a decrease in postoperative mortality with patients younger than 80 years old. In patients with a history of embolism and coronary artery disease, the cut-off points of the reduction in preoperative creatinine clearance associated with a increase in postoperative mortality are 30.8 mL.min and 56.6 mL.min.
据报道，术前肾功能不佳与预后不良相关。然而，对于术前肌酐清除率的理想值尚无具体讨论。因此，我们的主要目标是探讨基线肌酐清除率与心脏手术后短期死亡率之间的相关性。
我们基于一个法国心脏手术队列进行了二次数据分析。该队列包括2005年12月至2012年12月在巴黎一家大学医院的6889名参与者。本次二次分析中使用的暴露变量和结局变量分别是术前肌酐清除率和术后医院死亡率。采用了多变量逻辑回归和广义相加模型。
本研究观察到术前肌酐清除率与术后死亡之间存在非线性关系。在80岁以下患者中，术前肌酐清除率在8.9 - 78.5范围内与术后死亡率呈负相关（比值比 = 0.98，95%置信区间0.97 - 0.98，根据考克洛夫特-高尔特公式）。然而，术前肌酐清除率超过78.5后，这种效应特征达到饱和（比值比 = 0.99，95%置信区间0.98 - 1.00，考克洛夫特-高尔特公式）。有血栓栓塞事件和冠状动脉疾病病史的患者，饱和效应分别为30.8 mL.min（考克洛夫特-高尔特公式）和56.6 mL.min（考克洛夫特-高尔特公式）。
在8.9 - 78.5（考克洛夫特）范围内，80岁以下患者术前肌酐清除率升高与术后死亡率降低相关。有栓塞和冠状动脉疾病病史的患者，与术后死亡率增加相关的术前肌酐清除率降低的临界点分别为30.8 mL.min和56.6 mL.min。
