Nunes Sophia, Brown Jeremiah, Parikh Chirag R, Greenberg Jason H, Devarajan Prasad, Philbrook Heather Theissen, Pizzi Michael, Palijan Ana, Zappitelli Michael
Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
Departments of Epidemiology and Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH.
JTCVS Open. 2020 Jul 24;4:70-85. doi: 10.1016/j.xjon.2020.07.006. eCollection 2020 Dec.
Acute kidney injury (AKI) in children undergoing cardiac surgery (CS) is strongly associated with increased hospital mortality and length of stay. The association of AKI with postdischarge outcomes is unclear. We evaluated the association of AKI with all-cause readmissions and death within 30 days and 1 year of CS discharge.
This was a prospective, 3-center cohort study of children after CS with cardiopulmonary bypass. The primary exposures were postoperative ≥stage 1 AKI and ≥stage 2 AKI defined by Kidney Disease: Improving Global Outcomes AKI definition. Two separate outcomes were hospital readmission and death within 30 days and 1 year of discharge. Association of AKI with time to outcomes was determined using multivariable Cox-proportional hazards analysis. Age, The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery risk adjustment tool score ≥3, cardiopulmonary bypass >120 minutes, and cyanotic heart disease were evaluated as effect modifiers.
Of 402 participants included (median age 1.8 years [interquartile range 0.4, 5.2]), 32 (8.0%) and 109 (27.1%) were readmitted; 7 (1.7%) and 9 (2.2%) died within 30 days and 1 year of CS, respectively. AKI was not associated with readmission at 30 days or 1 year postdischarge. ≥Stage 2 AKI (adjusted hazard ratio, 11.68 [1.88, 72.61]) was associated with mortality 30 days post-CS.
Postoperative AKI was not associated with readmission at 30 days and 1-year postdischarge. However, more severe AKI (≥stage 2) appears to be associated with increased morality risk at 30 days post-CS.
接受心脏手术（CS）的儿童急性肾损伤（AKI）与医院死亡率和住院时间延长密切相关。AKI与出院后结局的关联尚不清楚。我们评估了AKI与CS出院后30天和1年内全因再入院及死亡的关联。
这是一项对接受体外循环心脏手术的儿童进行的前瞻性、多中心队列研究。主要暴露因素为根据改善全球肾脏病预后组织（KDIGO）AKI定义确定的术后≥1期AKI和≥2期AKI。两个独立的结局为出院后30天和1年内的医院再入院和死亡。使用多变量Cox比例风险分析确定AKI与结局发生时间的关联。将年龄、胸外科医师协会-欧洲心胸外科学会风险调整工具评分≥3、体外循环时间>120分钟和青紫型心脏病作为效应修饰因素进行评估。
纳入的402名参与者（中位年龄1.8岁[四分位间距0.4，5.2]）中，32名（8.0%）和109名（27.1%）再次入院；分别有7名（1.7%）和9名（2.2%）在CS后30天和1年内死亡。AKI与出院后30天或1年的再入院无关。≥2期AKI（调整后风险比，11.68[1.88，72.61]）与CS后30天的死亡率相关。
术后AKI与出院后30天和1年的再入院无关。然而，更严重的AKI（≥2期）似乎与CS后30天的死亡风险增加相关。
