Zhao Can, Li Yuntao, Pan Guangyu, Xu Jianping, Liu Shen, Xiao Yaqiong
Department of Cardiac Surgery, Peking University International Hospital, Beijing 102206, China.
J Cardiovasc Dev Dis. 2022 Jul 29;9(8):244. doi: 10.3390/jcdd9080244.
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.
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。