Drăgan Anca, Drăgan Adrian Ştefan
Department of Cardiovascular Anaesthesiology and Intensive Care, "Prof. Dr. C.C. Iliescu" Emergency Institute for Cardiovascular Diseases, 258 Fundeni Road, 022328 Bucharest, Romania.
Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, 050474 Bucharest, Romania.
Diagnostics (Basel). 2025 Aug 30;15(17):2211. doi: 10.3390/diagnostics15172211.
: Acute kidney injury (AKI) following cardiac surgery can lead to chronic kidney disease, increased hospitalization costs, and higher mortality risk. Our retrospective study identified risk factors of severe AKI (AKI 3) in patients undergoing on-pump surgical aortic valve replacement (SAVR). Additionally, we analyzed the significance of inflammatory indexes and risk scores in predicting AKI 3, focusing on sex differences. These findings could provide cost-efficient tools for clinical practice to identify patients at risk, improve preoperative risk stratification, and personalize monitoring. : We reviewed the on-pump SAVR patients from our tertiary center between 2022 and 2024. : Out of 422 patients, 121 (28.67%) experienced AKI, including 27 (6.39%) AKI 3 patients. The multivariable binary logistic regression identified AKI 3 independent risk factors: hemostasis reintervention (OR9.76, CI 95%: 3.565-26.716, = 0.001), early postoperative vasoactive-inotropic score (VIS) (OR1.049, CI 95%: 1.013-1.086, = 0.007), postoperative lymphocyte (OR2.252, CI 95%: 1.224-4.144, = 0.009). Preoperative systemic inflammatory response index (AUC0.700, = 0.019), preoperative aggregate index of systemic inflammation (AUC0.712, = 0.011), postoperative platelet-to-lymphocyte ratio (PLR) (AUC 0.759, = 0.001), and the delta value of preoperative-to-postoperative PLR (AUC0.752, = 0.001) were better predictors of AKI 3 occurrence in female SAVR patients than the additive EuroSCORE (AUC0.692, = 0.011), but were less accurate compared to EuroSCORE II (AUC0.841, = 0.001). None of the studied inflammatory indexes or additive EuroSCORE predicted our endpoint in male SAVR patients, while Thakar score was able to predict it exclusively in males. : Early postoperative VIS, lymphocyte count, and hemostasis reintervention were independent risk factors for severe AKI in SAVR patients. There is a differentiation between males and females from the AKI prediction perspective.
心脏手术后的急性肾损伤（AKI）可导致慢性肾脏病、住院费用增加和死亡风险升高。我们的回顾性研究确定了接受体外循环心脏手术主动脉瓣置换术（SAVR）患者发生严重AKI（AKI 3期）的危险因素。此外，我们分析了炎症指标和风险评分在预测AKI 3期方面的意义，重点关注性别差异。这些发现可为临床实践提供经济高效的工具，以识别有风险的患者，改善术前风险分层并实现个性化监测。
我们回顾了2022年至2024年期间来自我们三级中心的体外循环SAVR患者。
在422例患者中，121例（28.67%）发生了AKI，其中27例（6.39%）为AKI 3期患者。多变量二元逻辑回归确定了AKI 3期的独立危险因素：止血再干预（OR 9.76，95%CI：3.565 - 26.716，P = 0.001）、术后早期血管活性药物-正性肌力评分（VIS）（OR 1.049，95%CI：1.013 - 1.086，P = 0.007）、术后淋巴细胞（OR 2.252，95%CI：1.224 - 4.144，P = 0.009）。术前全身炎症反应指数（AUC 0.700，P = 0.019）、术前全身炎症综合指数（AUC 0.712，P = 0.011）、术后血小板与淋巴细胞比值（PLR）（AUC 0.759，P = 0.001）以及术前至术后PLR的差值（AUC 0.752，P = 0.001）在预测女性SAVR患者发生AKI 3期方面比相加性欧洲心脏手术风险评估系统（EuroSCORE）（AUC 0.692，P = 0.011）更好，但与欧洲心脏手术风险评估系统II（EuroSCORE II）（AUC 0.841，P = 0.001）相比准确性较低。在男性SAVR患者中，所研究的炎症指标或相加性EuroSCORE均不能预测我们的终点，而Thakar评分仅能在男性中预测该终点。
术后早期VIS、淋巴细胞计数和止血再干预是SAVR患者发生严重AKI的独立危险因素。从AKI预测角度来看，男性和女性之间存在差异。
