Department of Anesthesiology, National Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Center for Pediatric Cardiac Surgery, National Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ren Fail. 2023 Dec;45(1):2170244. doi: 10.1080/0886022X.2023.2170244.
Dysmagnesemia has been demonstrated to be involved in the pathophysiology of kidney diseases and is common in cardiac surgical patients. It remains unknown whether changes of serum magnesium after cardiac surgery affect AKI. We aimed to investigate the association of early postoperative magnesium with cardiac surgery-associated AKI in adults.
We conducted a multicenter retrospective cohort study involving patients who underwent cardiac surgery in the eICU Collaborative Research Database between 2014 and 2015. AKI within 7 days after surgery was defined using both serum creatinine and urine output criteria of Kidney Disease Improving Global Outcomes definition. Postoperative AKI was analyzed using multivariable logistic regression with early postoperative serum magnesium measured within the first 24 h after surgery as a continuous variable and categorically by quartiles.
Postoperative AKI was identified in 3498 of 6124 (57.1%) patients receiving cardiac surgery. The median (25th-75th percentiles) early postoperative serum magnesium level of the study population was 2.3 (2.0-2.7) mg/dL. Higher serum magnesium level was associated with a higher risk of developing postoperative AKI (adjusted odds ratio (OR), 1.46 per 1 mg/dL increase; 95% confidence interval (CI), 1.31-1.62; <.001). The multivariable-adjusted ORs (95% CIs) of postoperative AKI across increasing quartiles of serum magnesium were 1.00 (referent), 1.11 (0.95-1.29), 1.30 (1.12-1.52), and 1.72 (1.47-2.02) ( for trend <.001).
These data demonstrate a significantly higher incidence of AKI in patients with higher early postoperative serum magnesium who underwent cardiac surgery.
低镁血症已被证明与肾脏疾病的病理生理学有关，并且在心脏手术患者中很常见。心脏手术后血清镁的变化是否会影响急性肾损伤（AKI）尚不清楚。我们旨在研究成人心脏手术后早期镁变化与心脏手术相关 AKI 的关系。
我们进行了一项多中心回顾性队列研究，纳入了 2014 年至 2015 年在 eICU 协作研究数据库中接受心脏手术的患者。使用肾脏疾病改善全球结局（KDIGO）定义的血清肌酐和尿量标准在手术后 7 天内定义 AKI。使用多变量逻辑回归分析术后 AKI，将术后 24 小时内测量的早期术后血清镁作为连续变量，并按四分位数进行分类。
在接受心脏手术的 6124 例患者中，3498 例（57.1%）发生术后 AKI。研究人群的早期术后血清镁中位数（25 至 75 百分位数）为 2.3（2.0-2.7）mg/dL。较高的血清镁水平与发生术后 AKI 的风险增加相关（调整后的优势比（OR），每增加 1mg/dL 增加 1.46；95%置信区间（CI），1.31-1.62；<0.001）。血清镁四分位距增加时术后 AKI 的多变量调整 OR（95%CI）分别为 1.00（参照）、1.11（0.95-1.29）、1.30（1.12-1.52）和 1.72（1.47-2.02）（趋势<0.001）。
这些数据表明，接受心脏手术的患者中，早期术后血清镁较高者 AKI 的发生率显著较高。
