评估六种估算肾小球滤过率（eGFR）方程预测非体外循环冠状动脉旁路移植术后患者急性肾损伤的能力：一项病例对照研究。

Evaluation of Six eGFR Equations in Predicting Acute Kidney Injury in Patients after Off-Pump Coronary Artery Bypass Grafting: A Case Control Study.

作者信息

Tang Jiwen, Zhang Congcong, Hu Weiwei, Qu Weili

机构信息

Department of Cardiac Surgical Care Unit, Affiliated Hospital of Qingdao University, 266003 Qingdao, Shandong, China.

Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, 266003 Qingdao, Shandong, China.

出版信息

Rev Cardiovasc Med. 2024 Mar 28;25(4):120. doi: 10.31083/j.rcm2504120. eCollection 2024 Apr.

BACKGROUND

There are six widely used equations to calculate the estimated glomerular filtration rate (eGFR) of patients. We aimed to assess the predictive power of preoperative eGFR calculated by these equations for the occurrence of postoperative acute kidney injury (AKI).

METHODS

Patients who underwent isolated coronary surgery from January 2016 to January 2021 were continuously enrolled. Serum creatinine and cystatin C used to calculate eGFR were both measured within 1 week before surgery. The eGFR was calculated using six equations: Cockcroft Gault (CG) equation, Chinese abbreviated modification of diet in renal disease (MDRD) equation, chronic kidney disease-epidemiology (CKD-EPI) equation, and full age spectrum (FAS) equation. Postoperative AKI was diagnosed by Kidney Disease Improving Global Outcomes criteria (KDIGO) (① urine volume 0.5 mL/kg/h for 6 h; ② an increase in serum creatinine by 26.5 µmol/L within 48 h; ③ an increase in serum creatinine to 1.5 times baseline levels, which is known or presumed to have occurred within the prior 7 days), and the occurrence of AKI within 7 days after surgery was followed.

RESULTS

A total of 1428 patients were included, of which 319 patients (25.5%) developed postoperative AKI. After adjustment, all eGFRs (CG OR = 0.983, MDRD OR = 0.983, OR = 0.97, OR = 0.955, OR = 0.978, OR = 0. 941, all 0.001) were significantly associated with AKI. The area under the receiver operating characteristic curve (AUC) was 0.621 for CG, 0.614 for MDRD, 0.643 for , 0.739 for , 0.643 for , 0.744 for , respectively. There was no difference in predictive power between and ( = 0.33, DeLong's test).

CONCLUSIONS

Preoperative eGFR calculated by and equations have better performance in predicting AKI after off-pump coronary artery bypass grafting than other equations.

背景

有六种广泛使用的方程用于计算患者的估计肾小球滤过率（eGFR）。我们旨在评估通过这些方程计算的术前eGFR对术后急性肾损伤（AKI）发生的预测能力。

方法

连续纳入2016年1月至2021年1月接受单纯冠状动脉手术的患者。用于计算eGFR的血清肌酐和胱抑素C均在手术前1周内测量。使用六个方程计算eGFR：Cockcroft Gault（CG）方程、中国肾脏病饮食改良简化版（MDRD）方程、慢性肾脏病流行病学（CKD-EPI）方程和全年龄谱（FAS）方程。术后AKI根据改善全球肾脏病预后组织（KDIGO）标准进行诊断（①尿量<0.5 mL/kg/h持续6小时；②48小时内血清肌酐升高≥26.5 μmol/L；③血清肌酐升高至基线水平的≥1.5倍，已知或推测在之前7天内发生），并跟踪术后7天内AKI的发生情况。

结果

共纳入1428例患者，其中319例（25.5%）发生术后AKI。调整后，所有eGFR（CG OR = 0.983，MDRD OR = 0.983，[此处可能有信息缺失未明确的方程]OR = 0.97，[此处可能有信息缺失未明确的方程]OR = 0.955，[此处可能有信息缺失未明确的方程]OR = 0.978，[此处可能有信息缺失未明确的方程]OR = 0.941，均P<0.001）与AKI显著相关。CG的受试者工作特征曲线下面积（AUC）为0.621，MDRD为0.614，[此处可能有信息缺失未明确的方程]为0.643，[此处可能有信息缺失未明确的方程]为0.739，[此处可能有信息缺失未明确的方程]为0.643，[此处可能有信息缺失未明确的方程]为0.744。[此处可能有信息缺失未明确的方程]与[此处可能有信息缺失未明确的方程]在预测能力上无差异（P = 0.33，DeLong检验）。