Fan Xiaoguang, Shao Zehua, Gao Suhua, You Zhenzhen, Huo Shuai, Zhang Zhu, Li Qiuhong, Zhou Saijun, Yan Lei, Shao Fengmin, Yu Pei
NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China.
Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, China.
Front Cardiovasc Med. 2023 Mar 8;10:1108538. doi: 10.3389/fcvm.2023.1108538. eCollection 2023.
To retrospectively investigate the clinical characteristics and risk factors of cardiac surgery associated-acute kidney injury (CS-AKI) progressed to chronic kidney disease (CKD) in adults and to evaluate the performance of clinical risk factor model for predicting CS-AKI to CKD.
In this retrospective, observational cohort study, we included patients who were hospitalized for CS-AKI without a prior CKD [estimated glomerular filtration rate (eGFR) < 60 ml · min·1.73 m] at Central China Fuwai Hospital from January 2018 to December 2020. Survived patients were followed up for 90 days, the endpoint was CS-AKI to CKD, and then divided them into two groups (with or without CS-AKI to CKD). The baseline data including demographics, comorbidities, renal function, and other laboratory parameters were compared between two groups. The logistic regression model was used to analyze the risk factors for CS-AKI to CKD. Finally, receiver operator characteristic (ROC) curve was drawn to evaluate the performance of the clinical risk factor model for predicting CS-AKI to CKD.
We included 564 patients with CS-AKI (414 males, 150 females; age: 57.55 ± 11.86 years); 108 (19.1%) patients progressed to new-onset CKD 90 days after CS-AKI. Patients with CS-AKI to CKD had a higher proportion of females, hypertension, diabetes, congestive heart failure, coronary heart disease, low baseline eGFR and hemoglobin level, higher serum creatinine level at discharge (< 0.05) than those without CS-AKI to CKD. Multivariate logistic regression analysis revealed that female sex(= 3.478, 95% : 1.844-6.559, = 0.000), hypertension (= 1.835, 95% 1.046-3.220, = 0.034), coronary heart disease (= 1.779, 95% 1.015-3.118, = 0.044), congestive heart failure (= 1.908, 95% 1.124-3.239, = 0.017), preoperative low baseline eGFR (= 0.956, 95% 0.938-0.975, = 0.000), and higher serum creatinine level at discharge (= 1.109, 95% 1.014-1.024, = 0.000) were independent risk factors for CS-AKI to CKD. The clinical risk prediction model including female sex, hypertension, coronary heart disease, congestive heart failure, preoperative low baseline eGFR, and higher serum creatinine level at discharge produced a moderate performance for predicting CS-AKI to CKD (area under ROC curve = 0.859, 95% 0.823-0.896).
Patients with CS-AKI are at high risk for new-onset CKD. Female sex, comorbidities, and eGFR can help identify patients with a high risk for CS-AKI to CKD.
回顾性研究成人心脏手术相关急性肾损伤（CS-AKI）进展为慢性肾脏病（CKD）的临床特征和危险因素，并评估临床危险因素模型预测CS-AKI进展为CKD的性能。
在这项回顾性观察队列研究中，我们纳入了2018年1月至2020年12月在中国医学科学院阜外医院华中阜外医院因CS-AKI住院且既往无CKD[估计肾小球滤过率（eGFR）<60 ml·min·1.73 m²]的患者。对存活患者进行90天随访，终点为CS-AKI进展为CKD，然后将其分为两组（进展或未进展为CS-AKI至CKD）。比较两组患者的基线数据，包括人口统计学、合并症、肾功能和其他实验室参数。采用逻辑回归模型分析CS-AKI进展为CKD的危险因素。最后，绘制受试者工作特征（ROC）曲线，评估临床危险因素模型预测CS-AKI进展为CKD的性能。
我们纳入了564例CS-AKI患者（男性414例，女性150例；年龄：57.55±11.86岁）；108例（19.1%）患者在CS-AKI后90天进展为新发CKD。进展为CS-AKI至CKD的患者中女性、高血压、糖尿病、充血性心力衰竭、冠心病、基线eGFR和血红蛋白水平较低、出院时血清肌酐水平较高（<0.05）的比例高于未进展为CS-AKI至CKD的患者。多因素逻辑回归分析显示，女性（OR=3.478，95%CI：1.844-6.559，P=0.000）、高血压（OR=1.835，95%CI 1.046-3.220，P=0.034）、冠心病（OR=1.779，95%CI 1.015-3.118，P=0.044）、充血性心力衰竭（OR=1.908，95%CI 1.124-3.239，P=0.017）、术前基线eGFR较低（OR=0.956，95%CI 0.938-0.9
