术前估计肾小球滤过率预测非心脏大手术中的心脏事件：两项大型国际研究的二次分析

Preoperative estimated glomerular filtration rate to predict cardiac events in major noncardiac surgery: a secondary analysis of two large international studies.

作者信息

Roshanov Pavel S, Walsh Michael W, Garg Amit X, Cuerden Meaghan, Lam Ngan N, Hildebrand Ainslie M, Lee Vincent W, Mrkobrada Marko, Leslie Kate, Chan Matthew T V, Borges Flavia K, Wang Chew Yin, Xavier Denis, Sessler Daniel I, Szczeklik Wojciech, Meyhoff Christian S, Srinathan Sadeesh K, Sigamani Alben, Villar Juan Carlos, Chow Clara K, Polanczyk Carísi A, Patel Ameen, Harrison Tyrone G, Fielding-Singh Vikram, Cata Juan P, Parlow Joel, de Nadal Miriam, Devereaux P J

机构信息

Department of Medicine, Western University, London, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Outcomes Research Consortium, Houston, TX, USA.

Population Health Research Institute, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.

出版信息

Br J Anaesth. 2025 Feb;134(2):297-307. doi: 10.1016/j.bja.2024.10.039. Epub 2025 Jan 2.

DOI:10.1016/j.bja.2024.10.039

PMID:39753401

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11775841/

Abstract

BACKGROUND

Optimised use of kidney function information might improve cardiac risk prediction in noncardiac surgery.

METHODS

In 35,815 patients from the VISION cohort study and 9219 patients from the POISE-2 trial who were ≥45 yr old and underwent nonurgent inpatient noncardiac surgery, we examined (by age and sex) the association between continuous nonlinear preoperative estimated glomerular filtration rate (eGFR) and the composite of myocardial injury after noncardiac surgery, nonfatal cardiac arrest, or death owing to a cardiac cause within 30 days after surgery. We estimated contributions of predictive information, C-statistic, and net benefit from eGFR and other common patient and surgical characteristics to large multivariable models.

RESULTS

The primary composite occurred in 4725 (13.2%) patients in VISION and 1903 (20.6%) in POISE-2; in both studies cardiac events had a strong, graded association with lower preoperative eGFR that was attenuated by older age (P<0.001 for VISION; P=0.008 for POISE-2). For eGFR of 30 compared with 90 ml min 1.73 m, relative risk was 1.49 (95% confidence interval 1.26-1.78) at age 80 yr but 4.50 (2.84-7.13) at age 50 yr in female patients in VISION. This differed modestly (but not meaningfully) in men in VISION (P=0.02) but not in POISE-2 (P=0.79). eGFR contributed the most predictive information and mean net benefit of all predictors in both studies, most C-statistic in VISION, and third most C-statistic in POISE-2.

CONCLUSIONS

Continuous preoperative eGFR is among the best cardiac risk predictors in noncardiac surgery of the large set examined. Along with its interaction with age, preoperative eGFR would improve risk calculators.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov NCT00512109 (VISION) and NCT01082874 (POISE-2).

摘要

背景

优化肾功能信息的使用可能会改善非心脏手术中的心脏风险预测。

方法

在来自VISION队列研究的35815例患者和来自POISE-2试验的9219例年龄≥45岁且接受非急诊住院非心脏手术的患者中，我们（按年龄和性别）研究了术前连续非线性估计肾小球滤过率（eGFR）与非心脏手术后心肌损伤、非致命性心脏骤停或术后30天内心脏原因导致的死亡的综合情况之间的关联。我们估计了预测信息的贡献、C统计量以及eGFR和其他常见患者及手术特征对大型多变量模型的净效益。

结果

VISION研究中有4725例（13.2%）患者发生主要复合事件，POISE-2研究中有1903例（20.6%）；在两项研究中，心脏事件与术前较低的eGFR均呈强烈的分级关联，且这种关联在老年患者中减弱（VISION研究中P<0.001；POISE-2研究中P=0.008）。在VISION研究中，对于女性患者，eGFR为30与90 ml·min⁻¹·1.73 m²相比，80岁时相对风险为1.49（95%置信区间1.26 - 1.78），但50岁时为4.50（2.84 - 7.13）。在VISION研究中男性患者的情况略有不同（但无显著差异）（P=0.02），而在POISE-2研究中无差异（P=0.79）。在两项研究中，eGFR在所有预测因素中贡献的预测信息和平均净效益最多，在VISION研究中贡献的C统计量最多，在POISE-2研究中贡献的C统计量排第三。