Duchnowski Piotr, Śmigielski Witold
Cardinal Wyszynski National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland.
J Clin Med. 2024 Dec 20;13(24):7811. doi: 10.3390/jcm13247811.
Postoperative acute kidney injury (AKI) in patients undergoing heart valve surgery is a common complication requiring special treatment, including renal replacement therapy (RRT). Effective prevention remains the most effective tool to reduce this important clinical problem. The aim of the study was to evaluate the predictive abilities of selected perioperative parameters in predicting AKI requiring RRT in the early postoperative period in patients undergoing cardiac valve surgery. Prospective study on a group of patients undergoing cardiac valve surgery. The primary endpoint was postoperative AKI requiring RRT. The secondary endpoint was death in the RRT group. Logistic regression analysis was used to assess which variables predicted the primary and secondary endpoints. 603 patients were included in the study. The primary endpoint occurred in 43 patients. At multivariable analysis, age ( < 0.001), preoperative CRP level ( = 0.007), troponin T measured one day after surgery (TnT II) ( < 0.001) and prolonged postoperative use of catecholamines ( = 0.001) were independent predictors of the primary endpoint. In turn, death in the group of patients requiring RRT occurred in 32 patients. Age ( < 0.001), preoperative CRP level ( = 0.002), TnT II ( = 0.009), and prolonged postoperative use of catecholamines ( = 0.001) remained independent predictors of the secondary endpoint. The results of this study indicate that older age, elevated values of preoperative levels of CRP, as well as increasing levels of postoperative troponin T and the need for a prolonged supply of catecholamines, are independent predictors of postoperative AKI requiring RRT as well as death. Accurate identification of patients at increased postoperative risk of AKI could facilitate preoperative patient informed consent and optimize the process of qualification and cardiac surgical treatment.
心脏瓣膜手术患者术后急性肾损伤（AKI）是一种常见并发症，需要特殊治疗，包括肾脏替代治疗（RRT）。有效的预防仍然是减少这一重要临床问题的最有效手段。本研究的目的是评估所选围手术期参数对心脏瓣膜手术患者术后早期需要RRT的AKI的预测能力。对一组接受心脏瓣膜手术的患者进行前瞻性研究。主要终点是术后需要RRT的AKI。次要终点是RRT组的死亡情况。采用逻辑回归分析来评估哪些变量可预测主要和次要终点。603例患者纳入本研究。43例患者出现主要终点。在多变量分析中，年龄（<0.001）、术前C反应蛋白水平（=0.007）、术后第1天测得的肌钙蛋白T（TnT II）（<0.001）以及术后长时间使用儿茶酚胺（=0.001）是主要终点的独立预测因素。反过来，需要RRT的患者组中有32例死亡。年龄（<0.001）、术前C反应蛋白水平（=0.002）、TnT II（=0.009）以及术后长时间使用儿茶酚胺（=0.001）仍然是次要终点的独立预测因素。本研究结果表明，年龄较大、术前CRP水平升高、术后肌钙蛋白T水平升高以及需要长时间供应儿茶酚胺是术后需要RRT的AKI以及死亡的独立预测因素。准确识别术后AKI风险增加的患者有助于术前患者知情同意，并优化资格认定和心脏外科治疗过程。
