Department of Nephrology, Zhongshan Hospital, Fudan University, No 180 Fenglin Rd, Shanghai, China.
Department of Nephrology, Zhongshan Hospital (Xiamen), Fudan University, Fujian, China.
BMC Nephrol. 2024 Nov 1;25(1):393. doi: 10.1186/s12882-024-03802-9.
Acute kidney injury (AKI) is a major complication following cardiac surgery with a high incidence in those with existing kidney dysfunction. Platelet distribution width (PDW) reflects variability in platelet size and serves as an indicator of platelet activation. Recent investigations linked PDW changes to kidney pathology, suggesting its utility in identifying individuals at risk for AKI, thus necessitating exploration of its predictive value.
Patients with preoperative renal dysfunction [15 ≤ estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m] who underwent cardiac surgery from January 2018 to December 2021 were retrospectively enrolled. PDW values were measured preoperatively and again upon admission to the ICU immediately after cardiac surgery, with the change in PDW (dPDW) defined as the difference between these two measurements. The primary outcome was postoperative AKI, defined base on the Kidney Disease: Improving Global Outcomes (KDIGO) definition and staging criteria. Multivariate regression models were performed to identify the association between dPDW and AKI and its potential trend. Restricted cubic spline analysis assessed non-linear associations between dPDW and AKI. The Youden index identified an optimal dPDW cut-off for AKI prediction. Subgroup analysis was performed to elucidate the consistency of these associations across the various subgroups.
AKI occurred in 53.10% (513/966) of patients, accompanied by significant PDW increases in cases of AKI (P < 0.001). After adjusting confounders, dPDW was identified as a significant risk factor for AKI [odds ratio (OR) = 1.09, 95% confidence interval (CI): (1.02 ~ 1.16), P = 0.012]. Patients in the highest dPDW quartile (Q4) had a 195% higher AKI risk compared to those in the lowest quartile (Q1) (OR = 2.95, 95% CI:1.78 ∼ 4.90, P < 0.001). Trend analysis indicates that the risk of AKI increased with higher dPDW quartiles (P for trend < 0.001). Youden index showed that dRDW = 1.1 was identified as the optimal diagnostic cut-off value for AKI. Subgroup analyses and interaction tests showed a robust association between dPDW and AKI in all subgroups (P for interaction > 0.05).
This study underscored perioperative PDW changes as a significant predictor of postoperative AKI in patients with renal insufficiency, highlighting its potential in refining risk stratification and management strategies.
Not applicable for this observational retrospective study.
急性肾损伤（AKI）是心脏手术后的主要并发症，在存在肾功能障碍的患者中发病率较高。血小板分布宽度（PDW）反映了血小板大小的变化，可作为血小板激活的指标。最近的研究将 PDW 变化与肾脏病理联系起来，表明其在识别 AKI 风险患者方面具有一定的应用价值，因此需要探讨其预测价值。
回顾性纳入 2018 年 1 月至 2021 年 12 月期间因术前肾功能障碍（15≤估计肾小球滤过率[eGFR]＜60 ml/min/1.73m）而行心脏手术的患者。术前和心脏手术后即刻入住 ICU 时测量 PDW 值，定义 PDW 的变化（dPDW）为两次测量值之间的差值。主要结局为术后 AKI，根据肾脏疾病：改善全球结局（KDIGO）定义和分期标准定义。采用多变量回归模型来确定 dPDW 与 AKI 之间的关联及其潜在趋势。限制性立方样条分析评估了 dPDW 与 AKI 之间的非线性关联。约登指数确定了预测 AKI 的最佳 dPDW 截断值。进行亚组分析以阐明这些关联在各个亚组中的一致性。
966 例患者中 53.10%（513 例）发生 AKI，AKI 患者 PDW 显著升高（P＜0.001）。调整混杂因素后，dPDW 是 AKI 的显著危险因素[比值比（OR）=1.09，95%置信区间（CI）：（1.021.16），P=0.012]。dPDW 最高四分位数（Q4）患者 AKI 风险比最低四分位数（Q1）患者高 195%（OR=2.95，95%CI：1.784.90，P＜0.001）。趋势分析表明，AKI 风险随 dPDW 四分位数升高而增加（P 趋势＜0.001）。约登指数显示 dRDW=1.1 是预测 AKI 的最佳诊断截断值。亚组分析和交互检验表明，dPDW 与 AKI 之间存在稳健的关联，在所有亚组中均如此（P 交互＞0.05）。
本研究强调了围手术期 PDW 变化是肾功能不全患者术后 AKI 的重要预测因素，提示其在细化风险分层和管理策略方面具有潜在价值。
无（这是一项观察性回顾性研究，不需要临床试验注册号。）
