Suppr超能文献

接受体外循环再次心脏手术患者术后急性肾损伤的危险因素

Risk Factors for Postoperative Acute Kidney Injury in Patients Undergoing Redo Cardiac Surgery Using Cardiopulmonary Bypass.

作者信息

Zhao Can, Li Yuntao, Pan Guangyu, Xu Jianping, Liu Shen, Xiao Yaqiong

机构信息

Department of Cardiac Surgery, Peking University International Hospital, Beijing 102206, China.

出版信息

J Cardiovasc Dev Dis. 2022 Jul 29;9(8):244. doi: 10.3390/jcdd9080244.

Abstract

Objective: This paper aimed to investigate the incidence and risk factors of postoperative acute kidney injury (AKI) in adult patients undergoing redo cardiac surgery with cardiopulmonary bypass (CPB), and explore the impact of AKI on early outcomes. Methods: A total of 116 patients undergoing redo cardiac surgery with CPB between November 2017 and May 2021 were included. Patients were divided into two groups, AKI group and non-AKI group, according to the Kidney Disease Improving Global Outcomes criteria. Perioperative variables were retrospectively collected and analyzed. Risk factors for the development of AKI were investigated by univariate and multiple logistic regression models. Clinical outcomes were also compared between the groups. Results: Postoperative AKI occurred in 63 patients (54.3%), among whom renal replacement therapy was required in 12 patients (19.0%). The mechanical ventilation time (AKI: 43.00 (19.00, 72.00) hours; non-AKI: 18.00 (15.00, 20.00) hours; p < 0.001), ICU length of stay (AKI: 4.00 (2.00, 6.00) days; non-AKI: 3.00 (2.00, 4.00) days; p = 0.010), hospital length of stay since operation (AKI: 12.00 (8.00, 18.00) days; non-AKI: 9.00 (7.00, 12.50) days; p = 0.024), dialysis (AKI: 12.00 (19.05%); non-AKI: 0 (0%); p = 0.001), reintubation (AKI: 7.00 (11.11%); non-AKI: 0 (0%); p = 0.035), and hospital mortality (AKI: 8.00 (12.70%); non-AKI: 0 (0%); p = 0.020) were all higher in the AKI group than in the non-AKI group. Multivariate analysis revealed that high aspartate aminotransferase (OR, 1.028, 95% CI, 1.003 to 1.053, p = 0.025), coronary angiogram within 2 weeks before surgery (OR, 3.209, 95% CI, 1.307 to 7.878, p = 0.011) and CPB time (OR, 1.012, 95% CI, 1.005 to 1.019, p = 0.001) were independent risk factors for postoperative AKI. Conclusions: High aspartate aminotransferase, coronary angiogram within 2 weeks before surgery and CPB time seem to be associated with an increased incidence of postoperative AKI in patients with redo cardiac surgery.

摘要

目的

本文旨在研究接受体外循环(CPB)下再次心脏手术的成年患者术后急性肾损伤(AKI)的发生率及危险因素,并探讨AKI对早期预后的影响。方法:纳入2017年11月至2021年5月期间接受CPB下再次心脏手术的116例患者。根据改善全球肾脏病预后组织(KDIGO)标准将患者分为两组,即AKI组和非AKI组。回顾性收集并分析围手术期变量。通过单因素和多因素逻辑回归模型研究AKI发生的危险因素。比较两组间的临床结局。结果:63例患者(54.3%)发生术后AKI,其中12例患者(19.0%)需要肾脏替代治疗。AKI组的机械通气时间(AKI组:43.00(19.00,72.00)小时;非AKI组:18.00(15.00,20.00)小时;p<0.001)、重症监护病房(ICU)住院时间(AKI组:4.00(2.00,6.00)天;非AKI组:3.00(2.00,4.00)天;p = 0.010)、术后住院时间(AKI组:12.00(8.00,18.00)天;非AKI组:9.00(7.00,12.50)天;p = 0.024)、透析(AKI组:12.00(19.05%);非AKI组:0(0%);p = 0.001)、再次插管(AKI组:7.00(11.11%);非AKI组:0(0%);p = 0.035)及住院死亡率(AKI组:8.00(12.70%);非AKI组:0(0%);p = 0.020)均高于非AKI组。多因素分析显示,高天门冬氨酸氨基转移酶(比值比(OR),1.028,95%置信区间(CI),1.003至1.053,p = 0.025)、术前2周内冠状动脉造影(OR,3.209,95%CI,1.307至7.878,p = 0.011)及CPB时间(OR,1.012,95%CI,1.005至1.019,p = 0.001)是术后AKI的独立危险因素。结论:高天门冬氨酸氨基转移酶、术前2周内冠状动脉造影及CPB时间似乎与再次心脏手术患者术后AKI发生率增加有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/44e5/9409715/d625783a0205/jcdd-09-00244-g001.jpg

相似文献

4
Miniaturized cardiopulmonary bypass and acute kidney injury in coronary artery bypass graft surgery.
Ann Thorac Surg. 2009 Aug;88(2):529-35. doi: 10.1016/j.athoracsur.2009.03.072.
5
Reassessment of Acute Kidney Injury after Cardiac Surgery: A Retrospective Study.
Intern Med. 2017;56(3):275-282. doi: 10.2169/internalmedicine.56.7638. Epub 2017 Feb 1.
7
Risk factor for acute kidney injury in patients with chronic kidney disease receiving valve surgery with cardiopulmonary bypass.
Asian J Surg. 2021 Jan;44(1):229-234. doi: 10.1016/j.asjsur.2020.05.024. Epub 2020 Jul 2.
8
Acute kidney injury and prognosis after cardiopulmonary bypass: a meta-analysis of cohort studies.
Am J Kidney Dis. 2015 Feb;65(2):283-93. doi: 10.1053/j.ajkd.2014.09.008. Epub 2014 Nov 5.
9
Preoperative statin therapy is not associated with a reduced incidence of postoperative acute kidney injury after cardiac surgery.
Anesth Analg. 2010 Aug;111(2):324-30. doi: 10.1213/ANE.0b013e3181d8a078. Epub 2010 Apr 7.

引用本文的文献

1
Beyond ACEF: integrating biomarkers and intraoperative factors for enhanced AKI prediction post-SAVR.
Ren Fail. 2025 Dec;47(1):2528082. doi: 10.1080/0886022X.2025.2528082. Epub 2025 Jul 7.

本文引用的文献

1
Risk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery.
PLoS One. 2021 May 21;16(5):e0252209. doi: 10.1371/journal.pone.0252209. eCollection 2021.
2
Prediction of the development of acute kidney injury following cardiac surgery by machine learning.
Crit Care. 2020 Jul 31;24(1):478. doi: 10.1186/s13054-020-03179-9.
3
Risk factor for acute kidney injury in patients with chronic kidney disease receiving valve surgery with cardiopulmonary bypass.
Asian J Surg. 2021 Jan;44(1):229-234. doi: 10.1016/j.asjsur.2020.05.024. Epub 2020 Jul 2.
4
Cardiac surgery-associated acute kidney injury: pathophysiology and diagnostic modalities and management.
Cardiovasc J Afr. 2020 Jul/Aug;31(4):205-212. doi: 10.5830/CVJA-2019-069. Epub 2020 Jun 12.
6
Reoperative Cardiac Surgery Is a Risk Factor for Long-Term Mortality.
Ann Thorac Surg. 2020 Oct;110(4):1235-1242. doi: 10.1016/j.athoracsur.2020.02.028. Epub 2020 Mar 18.
7
The Role of Uric Acid in Acute Kidney Injury.
Nephron. 2019;142(4):275-283. doi: 10.1159/000499939. Epub 2019 Apr 16.
8
Hyperbilirubinemia Induces Pro-Apoptotic Effects and Aggravates Renal Ischemia Reperfusion Injury.
Nephron. 2019;142(1):40-50. doi: 10.1159/000496066. Epub 2019 Jan 23.
9
Clinical Outcomes of Mitral Valve Reoperations in the United States: An Analysis of The Society of Thoracic Surgeons National Database.
Ann Thorac Surg. 2019 Mar;107(3):754-759. doi: 10.1016/j.athoracsur.2018.08.083. Epub 2018 Oct 23.
10
Preoperative serum uric acid predicts incident acute kidney injury following cardiac surgery.
BMC Nephrol. 2018 Jul 4;19(1):161. doi: 10.1186/s12882-018-0970-x.

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验