Jiang Bo, Zhen Genshen, Yang Haiping, Hao Yi, Wang Meiping, Zhang Zhenhua, Chen Lin, He Ning, Chen Yueling, Jiang Li
Intensive Critical Unit, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
Department of Cardiac Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
Sci Rep. 2025 Jul 31;15(1):27933. doi: 10.1038/s41598-025-13719-4.
Preoperative kidney dysfunction is a predictor of acute kidney injury (AKI) following cardiac surgery, limited information exists regarding the impact of preoperative serum creatinine (sCr) change on AKI. This study aims to examine the association between the normalization of elevated preoperative sCr and postoperative AKI, as well as its severity and duration. This retrospective cohort study included patients undergoing open-heart surgery. Patients were categorized into three groups based on preoperative sCr change (ΔScr): the Stable sCr group (maximum ΔScr < 0.3 mg/dL throughout the preoperative period), the Normalized sCr group (maximum ΔScr ≥ 0.3 mg/dL followed by normalization to < 0.3 mg/dL within 48 h pre-surgery), and the Worsened sCr group (maximum ΔScr ≥ 0.3 mg/dL, remaining ≥ 0.3 mg/dL within 48 h pre-surgery). Multivariable logistic regression was used to evaluate the association between preoperative sCr change and postoperative AKI, severe AKI, and persistent AKI. To control for selection bias, propensity score matching (1:3) was used by matching covariates between the Normalized sCr and the Stable sCr group. Of the 560 patients included, 40.2% developed AKI. In the Normalized sCr group, the rate of AKI was 61.2%, severe AKI 22.4%, and persistent AKI 34.7%. Multivariable logistic regression analyses revealed the Normalized group was associated with higher risk of postoperative AKI (adjusted OR, 2.51; 95% CI, 1.30‒4.85, p = 0.006), severe AKI (adjusted OR, 3.40; 95% CI, 1.37-8.45, p = 0.008) and persistent AKI (adjusted OR, 2.87; 95% CI 1.36‒6.05, p = 0.006). After propensity matching, 184 patients were matched (46 in the Normalized sCr group and 138 in the Stable sCr group). The Normalized sCr group were still associated with risk of AKI (adjusted OR, 2.77; 95% CI, 1.34-5.73, p = 0.006), severe AKI (adjusted OR, 4.10; 95% CI, 1.32-12.71, p = 0.015) and persistent AKI (adjusted OR, 2.72; 95% CI, 1.21-6.15, p = 0.016). Normalization of preoperative sCr following an initial elevation was associated with higher risks of AKI, as well as AKI severity and duration.
术前肾功能不全是心脏手术后急性肾损伤（AKI）的一个预测指标，关于术前血清肌酐（sCr）变化对AKI的影响，现有信息有限。本研究旨在探讨术前升高的sCr恢复正常与术后AKI及其严重程度和持续时间之间的关联。这项回顾性队列研究纳入了接受心脏直视手术的患者。根据术前sCr变化（ΔScr）将患者分为三组：sCr稳定组（整个术前期间最大ΔScr＜0.3mg/dL）、sCr恢复正常组（最大ΔScr≥0.3mg/dL，随后在术前48小时内恢复至＜0.3mg/dL）和sCr恶化组（最大ΔScr≥0.3mg/dL，在术前48小时内保持≥0.3mg/dL）。采用多变量逻辑回归评估术前sCr变化与术后AKI、严重AKI和持续性AKI之间的关联。为控制选择偏倚，通过匹配sCr恢复正常组和sCr稳定组之间的协变量，采用倾向评分匹配（1:3）。在纳入的560例患者中，40.2%发生了AKI。在sCr恢复正常组中，AKI发生率为61.2%，严重AKI为22.4%，持续性AKI为34.7%。多变量逻辑回归分析显示，sCr恢复正常组术后发生AKI（调整后OR，2.51；95%CI，1.30‒4.85，p = 0.006）、严重AKI（调整后OR，3.40；95%CI，1.37 - 8.45，p = 0.008）和持续性AKI（调整后OR，2.87；95%CI 1.36‒6.05，p = 0.006）的风险更高。倾向匹配后，184例患者进行了匹配（sCr恢复正常组46例，sCr稳定组138例）。sCr恢复正常组仍与AKI（调整后OR，2.77；95%CI，1.34 - 5.73，p = 0.006）、严重AKI（调整后OR，4.10；95%CI，1.32 - 12.71，p = 0.015）和持续性AKI（调整后OR，2.72；95%CI，1.21 - 6.15，p = 0.016）的风险相关。术前sCr最初升高后恢复正常与AKI风险以及AKI严重程度和持续时间较高相关。
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