基于胱抑素C与肌酐评估的肾小球滤过率差异与接受大手术的成人不良事件的关联：一项多中心队列研究
Association of Differences in Estimated Glomerular Filtration Rate by Cystatin C versus Creatinine with Adverse Events in Adults Undergoing Major Surgery: A Multicenter Cohort Study.
作者信息
Cheng Yichun, Zhao Xingyang, Zhou Shiyu, Nie Sheng, Ge Shuwang, Xu Gang
机构信息
Division of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Division of Nephrology, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.
出版信息
Am J Nephrol. 2025 Jun 11:1-11. doi: 10.1159/000545915.
INTRODUCTION
The estimated glomerular filtration rate (eGFR) derived from either creatinine (eGFRcr) or cystatin C (eGFRcys) is common preoperative test in routine clinical practice. Recently, the difference between eGFRcys and eGFRcr (eGFRdiff) has been suggested to reflect health status and frailty. This study was aimed to determine the association of eGFRdiff with adverse events among adults undergoing major surgery.
METHODS
We conducted a retrospective cohort study of adults undergoing major surgery from 19 academic healthcare centers across China from January 1, 2013, to December 31, 2020. The eGFRdiff was categorized based on previous studied, that is, negative eGFRdiff (<-15 mL/min/1.73 m2), midrange eGFRdiff (-15 to 15 mL/min/1.73 m2), and positive eGFRdiff (≥15 mL/min/1.73 m2). Multivariate logistic regression was performed to assess the association of eGFRdiff with 30-day mortality, 90-day mortality, admission to intensive care unit (ICU), and development of postoperative acute kidney injury (AKI) after surgery.
RESULTS
Among 158,336 participants undergoing major surgery, the mean age was 57 years and 52.5% were male. The most frequent surgery type was general (47.5%), followed by the orthopedic (17.0%) and thoracic surgery (12.9%). The mean eGFRdiff was -7.6 mL/min/1.73 m2, negative (<-15 mL/min/1.73 m2) and positive (≥15 mL/min/1.73 m2) eGFRdiff values were observed in 36.1% and 11.6% participants, respectively. In multivariable analyses after adjustment for confounding factors, the negative eGFRdiff had OR of 1.34 (95% CI: 1.20-1.50) for 30-day mortality, 1.33 (95% CI: 1.23, 1.43) for 90-day mortality, 1.46 (95% CI: 1.41-1.50) for admission to ICU, and 1.39 (95% CI: 1.32-1.46) for postoperative AKI. Moreover, the positive eGFRdiff was associated lower risk of 90-days mortality, admission to ICU, and postoperative AKI.
CONCLUSIONS
Negative GFRdiff may be a valuable marker for identifying individuals at a higher risk of adverse events in participants undergoing major surgery.
引言
根据肌酐（eGFRcr）或胱抑素C（eGFRcys）得出的估计肾小球滤过率（eGFR）是常规临床实践中常见的术前检查项目。最近，有人提出eGFRcys与eGFRcr之间的差异（eGFRdiff）可反映健康状况和虚弱程度。本研究旨在确定eGFRdiff与接受大手术的成年人不良事件之间的关联。
方法
我们对2013年1月1日至2020年12月31日期间来自中国19个学术医疗中心接受大手术的成年人进行了一项回顾性队列研究。根据先前的研究对eGFRdiff进行分类，即负eGFRdiff（<-15 mL/min/1.73 m2）、中等范围eGFRdiff（-15至15 mL/min/1.73 m2）和正eGFRdiff（≥15 mL/min/1.73 m2）。进行多因素逻辑回归分析，以评估eGFRdiff与术后30天死亡率、90天死亡率、入住重症监护病房（ICU）以及术后急性肾损伤（AKI）发生之间的关联。
结果
在158,336名接受大手术的参与者中，平均年龄为57岁，男性占52.5%。最常见的手术类型是普通外科手术（47.5%），其次是骨科手术（17.0%）和胸外科手术（12.9%）。平均eGFRdiff为-7.6 mL/min/1.73 m2，分别有36.1%和11.6%的参与者eGFRdiff值为负（<-15 mL/min/1.73 m2）和正（≥15 mL/min/1.73 m2）。在对混杂因素进行调整后的多变量分析中，负eGFRdiff组术后30天死亡率的比值比（OR）为1.34（95%置信区间：1.20-1.50），90天死亡率的OR为1.33（95%置信区间：1.23, 1.43），入住ICU的OR为1.46（95%置信区间：1.41-1.50），术后AKI的OR为1.39（95%置信区间：1.
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