Demirjian Sevag, Huml Anne, Bakaeen Faisal, Poggio Emilio, Geube Mariya, Shaw Andrew, Gillinov A Marc, Gadegbeku Crystal A
Cleveland Clinic.
Res Sq. 2024 Mar 14:rs.3.rs-3660617. doi: 10.21203/rs.3.rs-3660617/v1.
Female sex has been recognized as a risk factor for cardiac surgery associated acute kidney injury (CS-AKI). The current study sought to evaluate whether female sex is a risk factor for CS-AKI, or modifies the association of peri-operative change in serum creatinine with CS-AKI.
Observational study of adult patients undergoing cardiac surgery between 2000 and 2019 in a single U.S. center. The main variable of interest was registered patient sex, identified from electronic medical records. The main outcome was CS-AKI within 2 weeks of surgery.
Of 58526 patients, 19353 (33%) were female; 12934 (22%) incurred AKI based on ≥ 0.3 mg/dL or ≥ 50% rise in serum creatinine (any AKI), 3320 (5.7%) had moderate to severe AKI, and 1018 (1.7%) required dialysis within 2 weeks of surgery. Female sex was associated with higher risk for AKI in models that were based on preoperative serum creatinine (OR, 1.35; 95% CI, 1.29-1.42), and lower risk with the use of estimated glomerular filtration, (OR, 0.90; 95% CI, 0.86-0.95). The risk for moderate to severe CS-AKI for a given immediate peri-operative change in serum creatinine was higher in female compared to male patients (p < .0001 and p < .0001 for non-linearity), and the association was modified by pre-operative kidney function (p < .0001 for interaction).
The association of patient sex with CS-AKI and its direction was dependent on the operational definition of pre-operative kidney function, and differential outcome misclassification due to AKI defined by absolute change in serum creatinine.
女性已被确认为心脏手术相关急性肾损伤（CS-AKI）的危险因素。本研究旨在评估女性是否为CS-AKI的危险因素，或是否会改变血清肌酐围手术期变化与CS-AKI之间的关联。
对2000年至2019年在美国一家中心接受心脏手术的成年患者进行观察性研究。主要关注变量为登记的患者性别，从电子病历中识别。主要结局为术后2周内发生CS-AKI。
在58526例患者中，19353例（33%）为女性；12934例（22%）根据血清肌酐升高≥0.3mg/dL或≥50%发生急性肾损伤（任何急性肾损伤），3320例（5.7%）发生中重度急性肾损伤，1018例（1.7%）在术后2周内需要透析。在基于术前血清肌酐的模型中，女性与急性肾损伤风险较高相关（OR，1.35；95%CI，1.29-1.42），而使用估算肾小球滤过率时风险较低（OR，0.90；95%CI，0.86-0.95）。对于给定的围手术期血清肌酐即时变化，女性患者发生中重度CS-AKI的风险高于男性患者（非线性p<0.0001和p<0.0001），且该关联因术前肾功能而改变（交互作用p<0.0001）。
患者性别与CS-AKI的关联及其方向取决于术前肾功能的操作定义，以及因血清肌酐绝对变化定义的急性肾损伤导致的不同结局错误分类。
