Molina Andújar Alícia, Escudero Victor Joaquin, Piñeiro Gaston J, Lucas Alvaro, Rovira Irene, Matute Purificación, Ibañez Cristina, Blasco Miquel, Quintana Luis F, Sandoval Elena, Sánchez Marina Chorda, Quintana Eduard, Poch Esteban
Nephrology and Kidney Transplantation Department, Hospital Clínic, Barcelona, Spain.
Faculty of Medicine, University of Barcelona, Barcelona, Spain.
Front Nephrol. 2023 Apr 24;3:1059668. doi: 10.3389/fneph.2023.1059668. eCollection 2023.
The incidence of acute kidney injury following cardiac surgery (CSA-AKI) is up to 30%, and the risk of chronic kidney disease (CKD) has been found to be higher in these patients compared to the AKI-free population. The aim of our study was to assess the risk of major adverse kidney events (MAKE) [25% or greater decline in estimated glomerular filtration rate (eGFR), new hemodialysis, and death] after cardiac surgery in a Spanish cohort and to evaluate the utility of the score developed by Legouis D et al. (CSA-CKD score) in predicting the occurrence of MAKE.
This was a single-center retrospective study of patients who required cardiac surgery with cardiopulmonary bypass (CPB) during 2015, with a 1-year follow-up after the intervention. The inclusion criteria were patients over 18 years old who had undergone cardiac surgery [i.e., valve substitution (VS), coronary artery bypass graft (CABG), or a combination of both procedures].
The number of patients with CKD (eGFR < 60 mL/min) increased from 74 (18.3%) to 97 (24%) within 1 year after surgery. The median eGFR declined from 85 to 82 mL/min in the non-CSA-AKI patient group and from 73 to 65 mL/min in those with CSA-AKI ( = 0.024). Fifty-eight patients (1.4%) presented with MAKE at the 1-year follow-up. Multivariate logistic regression analysis showed that the only variable associated with MAKE was CSA-AKI [odds ratio (OR) 2.386 (1.31-4.35), = 0.004]. The median CSA-CKD score was higher in the MAKE cohort [3 (2-4) vs. 2 (1-3), p < 0.001], but discrimination was poor, with a receiver operating characteristic curve (AUC) value of 0.682 (0.611-0.754).
Any-stage CSA-AKI is associated with a risk of MAKE after 1 year. Further research into new measures that identify at-risk patients is needed so that appropriate patient follow-up can be carried out.
心脏手术后急性肾损伤（CSA-AKI）的发生率高达30%，与未发生急性肾损伤的人群相比，这些患者患慢性肾脏病（CKD）的风险更高。我们研究的目的是评估西班牙队列中心脏手术后发生主要不良肾脏事件（MAKE）[估计肾小球滤过率（eGFR）下降25%或更多、开始新的血液透析和死亡]的风险，并评估Legouis D等人制定的评分（CSA-CKD评分）在预测MAKE发生方面的效用。
这是一项对2015年期间需要进行体外循环（CPB）心脏手术的患者进行的单中心回顾性研究，干预后进行1年随访。纳入标准为年龄超过18岁且接受过心脏手术的患者[即瓣膜置换术（VS）、冠状动脉旁路移植术（CABG）或两种手术联合]。
CKD（eGFR<60 mL/min）患者数量在术后1年内从74例（18.3%）增加到97例（24%）。非CSA-AKI患者组的eGFR中位数从85 mL/min降至82 mL/min，而CSA-AKI患者组从73 mL/min降至65 mL/min（P=0.024）。58例患者（1.4%）在1年随访时出现MAKE。多因素逻辑回归分析显示，与MAKE相关的唯一变量是CSA-AKI[比值比（OR）2.386（1.31-4.35），P=0.004]。MAKE队列中的CSA-CKD评分中位数更高[3（2-4）对2（1-3），P<0.001]，但区分能力较差，受试者工作特征曲线（AUC）值为0.682（0.611-0.754）。
任何阶段的CSA-AKI都与1年后发生MAKE的风险相关。需要进一步研究识别高危患者的新措施，以便对患者进行适当的随访。
