Department of Anesthesiology, The Second Affiliated Hospital, School of Medicine, South China University of Technology, No.1, Panfu RD, Yuexiu District, Guangzhou, 510180, China.
Guangdong Medical University, Zhanjiang, 524023, China.
J Cardiothorac Surg. 2024 Oct 23;19(1):612. doi: 10.1186/s13019-024-03100-3.
This study was to analyze the roles of red blood cell distribution width (RDW), anion gap (AG) levels and their combined effects on the risk of acute kidney injury (AKI) following cardiac surgery.
This cohort study extracted the data of 1951 participants aged ≥ 18 years with the assessment of AKI after cardiac surgery during ICU stay from MIMIC-IV database between 2008 and 2019. Receiver operator characteristic (ROC) curve was used to determine the optimal cut-off value AG and RDW. The associations between AG, RDW, and the combined effects of AG and effects were evaluated via univariable and multivariable Logistic models. Odds ratio (OR) with 95% confidence interval (CI) were imputed.
Among all the participants, 831 participants had AKI, and 1120 did not have AKI. ROC curves revealed that the optimum cut of points of AG and RDW were 12.75 mmol/L, and 13.65%, respectively. Increased risk of AKI was found in patients after cardiac surgery with AG > 12.75 mmol/L (OR = 1.44, 95%CI 1.15-1.80) or RDW > 13.65% group (OR = 1.23, 95%CI 1.01-1.50). In comparison to subjects with AG ≤ 12.75 mmol/L and RDW ≤ 13.65%, AG > 12.75 mmol/L and RDW ≤ 13.65% (OR = 1.42, 95%CI 1.07-1.89), and AG > 12.75 mmol/L and RDW > 13.65% (OR = 1.75, 95%CI 1.24-2.47) were associated with increased odds of AKI in patients after cardiac surgery.
AG and RDW had combined effects on risk of AKI in patients after cardiac surgery, which might offer an insight for the management of patients after cardiac surgery.
本研究旨在分析红细胞分布宽度（RDW）、阴离子间隙（AG）水平及其联合作用对心脏手术后急性肾损伤（AKI）风险的影响。
本队列研究从 2008 年至 2019 年期间的 MIMIC-IV 数据库中提取了 1951 名年龄≥18 岁、在 ICU 期间接受心脏手术后发生 AKI 的患者数据。采用受试者工作特征（ROC）曲线确定 AG 和 RDW 的最佳截断值。通过单变量和多变量 Logistic 模型评估 AG、RDW 以及 AG 和 RDW 联合效应之间的关系。采用 95%置信区间（CI）计算比值比（OR）。
在所有参与者中，831 名患者发生 AKI，1120 名患者未发生 AKI。ROC 曲线显示，AG 和 RDW 的最佳截断点分别为 12.75mmol/L 和 13.65%。与 AG<12.75mmol/L 或 RDW<13.65%的患者相比，心脏手术后 AG>12.75mmol/L（OR=1.44，95%CI 1.15-1.80）或 RDW>13.65%（OR=1.23，95%CI 1.01-1.50）的患者发生 AKI 的风险增加。与 AG<12.75mmol/L 和 RDW<13.65%的患者相比，AG>12.75mmol/L 和 RDW<13.65%（OR=1.42，95%CI 1.07-1.89）和 AG>12.75mmol/L 和 RDW>13.65%（OR=1.75，95%CI 1.24-2.47）的患者发生 AKI 的风险更高。
AG 和 RDW 对心脏手术后 AKI 风险具有联合作用，为心脏手术后患者的管理提供了新的视角。
