Vlasov Hanna E, Petäjä Liisa M, Wilkman Erika M, Talvasto Akseli T, Ilmakunnas Minna K, Raivio Peter M, Hiippala Seppo T, Suojaranta Raili T, Juvonen Tatu S, Pesonen Eero J
Department of Anesthesiology and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Anesthesiology and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
J Cardiothorac Vasc Anesth. 2025 Jul;39(7):1696-1705. doi: 10.1053/j.jvca.2025.03.006. Epub 2025 Mar 6.
To study the association between bleeding and acute kidney injury (AKI).
Post-hoc study of a randomized trial of 4% albumin versus Ringer's acetate for cardiopulmonary bypass priming and perioperative volume replacement.
Single-center study.
1,386 on-pump cardiac surgical patients.
AKI was defined by the Kidney Disease: Improving Global Outcomes creatinine criteria, and bleeding by the Universal Definition of Perioperative Bleeding (UDPB) classification. With univariably independent factors, two logistic regression analyses (Model 1: AKI Risk Score, EuroSCORE II, and UDPB class; Model 2: risk scores, components of the UDPB classification, and factor VIII/von Willebrand factor concentrate) and a mediation analysis (Model 3: risk scores, UDPB class, and perioperative factors) were performed. A total of 139 (10%) patients developed AKI. In Model 1, UDPB class "severe" (odds ratio: 2.16, 95% confidence interval: 1.19-3.89), "massive" bleeding (6.78, 1.8-25.33), and AKI Risk Score (1.51, 1.29-1.78) were associated with AKI. In Model 2, AKI Risk Score (1.55, 1.33-1.82) and fresh frozen plasma transfusion (1.29, 1.06-1.58) were associated with AKI. In Model 3, the combined UDPB classes "severe" and "massive" bleeding did not have a direct effect (regression coefficient: 0.32, 95% confidence interval: -0.26 to 0.91), while mean arterial pressure (0.08, 0.003-0.21) and fluid balance (0.12, 0.17-0.27) had indirect effects on AKI.
In on-pump cardiac surgery, perioperative bleeding was not an independent risk factor for AKI but manifested as AKI via hypotension and higher fluid balance. Prevention of bleeding may reduce AKI in cardiac surgery.
研究出血与急性肾损伤（AKI）之间的关联。
一项关于4%白蛋白与醋酸林格液用于体外循环预充和围手术期容量替代的随机试验的事后分析研究。
单中心研究。
1386例接受心脏手术的患者。
AKI根据肾脏病：改善全球预后（KDIGO）肌酐标准定义，出血根据围手术期出血通用定义（UDPB）分类。通过单变量独立因素，进行了两项逻辑回归分析（模型1：AKI风险评分、欧洲心脏手术风险评估系统II（EuroSCORE II）和UDPB分类；模型2：风险评分、UDPB分类的组成部分以及凝血因子VIII/血管性血友病因子浓缩物）和一项中介分析（模型3：风险评分、UDPB分类和围手术期因素）。共有139例（10%）患者发生AKI。在模型1中，UDPB分类“严重”（比值比：2.16，95%置信区间：1.19 - 3.89）、“大量”出血（6.78，1.8 - 25.33）和AKI风险评分（1.51，1.29 - 1.78）与AKI相关。在模型2中，AKI风险评分（1.55，1.33 - 1.82）和新鲜冰冻血浆输注（1.29，1.06 - 1.58）与AKI相关。在模型3中，合并的UDPB分类“严重”和“大量”出血没有直接影响（回归系数：0.32，95%置信区间： - 0.26至0.91），而平均动脉压（0.08，0.003 - 0.21）和液体平衡（0.12，0.17 - 0.27）对AKI有间接影响。
在心脏手术中，围手术期出血不是AKI的独立危险因素，但可通过低血压和更高的液体平衡表现为AKI。预防出血可能降低心脏手术中的AKI发生率。
