非体外循环下冠状动脉旁路移植术后急性肾损伤的相关因素分析

目的探讨非体外循环下冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)后发生急性肾损伤(acute kidney injury,AKI)的危险因素。方法回顾性分析2013年1月~2015年2月我院156例择期OPCABG的临床资料,根据急性肾损伤网络小组(acute kidney injury network,AKIN)的AKI诊断标准,将患者分成2组:AKI组(n=54)及非AKI组(n=102),对2组患者术前、术中及术后可能与发生AKI有关的变量进行单因素分析,有差异的变量进行logistic回归分析,筛选出OPCABG后发生AKI的危险因素。结果 OPCABG术后AKI发生率为34.6%(54/156),其中2例行透析治疗,后均因急性心功能衰竭死亡。单因素分析显示:年龄70岁、高血压病史、糖尿病史、糖化血清蛋白值、术前BNP、术后BNP、术前血肌酐、术前LVEF(左室射血分数)40%、室间隔厚度、术中输注悬浮红细胞及血浆量、ICU停留时间、机械通气时间、术后住院时间差异具有统计学意义(P0.05)。logistics回归分析显示:年龄70岁(OR=4.988,95%CI:1.098~22.649,P=0.043),高血压病史(OR=3.323,95%CI:2.718~8.582,P=0.026),糖尿病史(OR=2.004,95%CI:1.277~3.145,P=0.019),糖化血清蛋白(OR=1.716,95%CI:0.646~4.710,P=0.016),术前血肌酐(OR=7.149,95%CI:6.969~7.334,P=0.023),术前LVEF40%(OR=12.138,95%CI:7.448~19.846,P=0.008),术中输注悬浮红细胞(OR=1.891,95%CI:1.283~2.787,P=0.007),术中输注血浆量(OR=1.491,95%CI:1.374~1.652,P=0.039),机械通气时间(OR=2.665,95%CI:2.608~2.723,P=0.008)为OPCABG术后发生AKI的危险因素。结论 AKI的发生与多种围手术期危险因素有关,应充分重视这些危险因素的评估。     

法洛四联症根治术后急性肾损伤的危险因素分析

目的探索法洛四联症(tetralogy of Fallot,TOF)患者术后急性肾损伤(acute kidney injury,AKI)的危险因素。方法本研究采用回顾性队列研究法。纳入2010年3月1日至2013年3月1日于阜外医院TOF根治术患者726例。以急性肾损伤网络工作小组(AKIN)作为AKI的诊断标准,将患者分为AKI组(240例)和非AKI组(486例)。采取单因素分析法,比较两组之间的差异性变量。单因素分析中P0.1的变量纳入二元logistic模型,用以分析变量的显著性差异。结果单因素分析结果显示:AKI组和非AKI组患者年龄、Nakata指数、Mc Goon比值、左心室舒张期末容积指数(left ventricular end-diastolic volume index,LVEDVI)、跨环补片、术中输注新鲜冷冻血浆(fresh frozen plasma,FFP)差异有统计学意义。二元logistic分析显示:AKI组患儿年龄较大(OR=1.425,95%CI 1.071~1.983,P=0.011),AKI组Nakata指数(OR=0.282,95%CI 0.092~0.869,P=0.013)较小,AKI组术中输注FFP较多(OR=1.468,95%CI 1.325~2.674,P0.001)。结论 Nakata指数越小TOF患者根治术后AKI的发病率越高。TOF根治手术时患儿年龄越大术后AKI的发病率越高。术中输注FFP可能会导致术后AKI的发病率增高。     

非体外循环下冠状动脉旁路移植术后急性肾损伤的相关因素分析北大核心CSCD

目的探讨非体外循环下冠状动脉旁路移植术（off-pump coronary artery bypass grafting,OPCABG）后发生急性肾损伤（acute kidney injury,AKI）的危险因素。方法回顾性分析2013年1月~2015年2月我院156例择期OPCABG的临床资料,根据急性肾损伤网络小组（acute kidney injury network,AKIN）的AKI诊断标准,将患者分成2组：AKI组（n=54）及非AKI组（n=102）,对2组患者术前、术中及术后可能与发生AKI有关的变量进行单因素分析,有差异的变量进行logistic回归分析,筛选出OPCABG后发生AKI的危险因素。结果 OPCABG术后AKI发生率为34.6%（54/156）,其中2例行透析治疗,后均因急性心功能衰竭死亡。单因素分析显示：年龄〉70岁、高血压病史、糖尿病史、糖化血清蛋白值、术前BNP、术后BNP、术前血肌酐、术前LVEF（左室射血分数）〈40%、室间隔厚度、术中输注悬浮红细胞及血浆量、ICU停留时间、机械通气时间、术后住院时间差异具有统计学意义（P〈0.05）。logistics回归分析显示：年龄〉70岁（OR=4.988,95%CI：1.098~22.649,P=0.043）,高血压病史（OR=3.323,95%CI：2.718~8.582,P=0.026）,糖尿病史（OR=2.004,95%CI：1.277~3.145,P=0.019）,糖化血清蛋白（OR=1.716,95%CI：0.646~4.710,P=0.016）,术前血肌酐（OR=7.149,95%CI：6.969~7.334,P=0.023）,术前LVEF〈40%（OR=12.138,95%CI：7.448~19.846,P=0.008）,术中输注悬浮红细胞（OR=1.891,95%CI：1.283~2.787,P=0.007）,术中输注血浆量（OR=1.491,95%CI：1.374~1.652,P=0.039）,机械通气时间（OR=2.665,95%CI：2.608~2.723,P=0.008）为OPCABG术后发生AKI的危险因素。结论 AKI的发生与多种围手术期危险因素有关,应充分重视这些危险因素的评估。     

急性肾损伤定义及分期系统评估心脏手术患者预后的临床价值

目的了解心脏手术后急性肾损伤(AKI)的发病及预后情况,探讨急性肾损伤网络(AKIN)会议推荐的AKI分期预测患者院内死亡的应用价值。方法将2004年1月至2007年6月上海交通大学医学院附属仁济医院收治的所有成年心脏手术患者1 056例纳入研究,采用AKIN推荐的AKI定义及分期标准评估心脏手术后AKI的发病率及住院病死率,并采用单因素和logistic多因素回归分析法对术前、术中、术后与AKI发生可能相关的危险因素进行分析。结果在1 056例行心脏手术的患者中,328例发生AKI,发生率为31.06%;AKI患者的住院病死率显著高于非AKI患者(11.59%vs.0.69%,P<0.05)。Logistic多因素回归分析显示:年龄每增加10岁(OR=1.40)、术前高尿酸血症(OR=1.97)、术前左心功能不全(OR=2.53)、冠状动脉旁路移植术(CABG)加心瓣膜手术(OR=2.79)、手术时间每增加1 h(OR=1.43)和术后循环血容量不足(OR=11.08)是心脏手术后发生AKI的独立危险因素。AKIN分期预测患者院内死亡的ROC曲线下面积为0.865,95%可信区间为0.801-0.929。结论随着AKIN分期的上升,心脏手术患者住院病死率逐步升高。年龄高、术前高尿酸血症、术前左心功能不全、CABG加心瓣膜手术、手术时间延长和术后循环血容量不足是心脏手术后并发AKI的独立危险因素。AKIN分期可以有效预测心脏手术患者发生院内死亡的风险,为及早对高危人群采取有效的预防干预措施提供依据。     

合并巨大左心室的心脏瓣膜病患者术后发生急性肾损伤的危险因素分析

目的 探讨合并巨大左心室的心脏瓣膜病患者心脏瓣膜术后发生急性肾损伤(AKI)的危险因素。方法 回顾性分析2018-01—2020-12在阜外华中心血管病医院行心脏瓣膜手术且合并巨大左心室的心脏瓣膜病患者的临床资料，根据术后是否发生AKI,分为AKI组和非AKI组。比较2组患者的基线、术中和术后资料。将单因素分析中P<0.2的变量放入多因素Logistic回归方程中，分析AKI与各因素的相关性。随后将连续型变量放入构建的回归模型中进行趋势性检验，进一步分析连续型变量对AKI的影响。结果 研究共纳入132例合并巨大左心室的心脏瓣膜病患者，年龄(52.9±12.5)岁；28例于术后发生AKI,非AKI组104例。单因素分析结果显示，合并糖尿病、合并脑血管疾病、围术期输血、主动脉阻断时间、体外循环时间等项目的差异有统计学意义(P<0.05)。多因素Logistic回归分析显示，基础血肌酐升高(OR=3.311,95%CI 1.086～10.096,P=0.035)、主动脉阻断时间(OR=1.022,95%CI 1.008～1.037,P=0.003)、围术期输血(OR=2.850,...     

心脏瓣膜置换患者术后急性肾损伤风险预测模型的建立与验证

目的建立心脏瓣膜置换术后急性肾损伤(acute kidney injury, AKI)的风险预测模型并进行验证。方法选择2016年1月1日至2021年12月31日在徐州市中心医院接受心脏瓣膜置换术的患者为研究对象, 采用Logistic回归模型筛选患者发生AKI的独立危险因素, 并建立列线图预测模型。采用受试者工作特征曲线(ROC曲线)、校准曲线及决策曲线分析法(DCA)对预测模型进行验证。结果共619例心脏瓣膜置换患者入选本研究, 其中术后发生AKI 74例(11.95%)。多因素Logistic回归分析结果显示, 高龄(OR=3.826, 95%CI 2.267～6.458)、合并高血压(OR=2.376, 95%CI 1.162～4.861)、体外循环时间延长(OR=1.049, 95%CI 1.024～1.074)、血白细胞计数升高(OR=1.066, 95%CI 1.027～1.106)、血小板计数降低(OR=0.994, 95%CI 0.990～0.997)及淋巴细胞比例降低(OR=0.873, 95%CI 0.774～0.985)是心脏瓣膜置换患者术后发生AKI的独立危险...     

急性A型主动脉夹层术后急性肾损伤危险因素的系统评价与Meta分析

目的系统评价急性A型主动脉夹层术后急性肾损伤(AKI)的危险因素。方法计算机检索中国学术期刊全文数据库(CNKI)、万方数据库、中文科技期刊数据库、PubMed、Web of Science及Cochrane Library,检索时间从建库至2019年1月。收集有关急性A型主动脉夹层术后AKI的临床研究。采用卡斯尔-渥太华量表(NOS)评价纳入研究的质量。采用RevMan 5.3软件对收集的资料进行Meta分析。结果最终纳入16项研究,均为病例对照研究,共1 728例患者,纳入研究NOS评分均为6分以上。Meta分析结果显示,性别[OR=1.58,95%CI(1.31,1.89),P0.001]、体重指数[OR=1.05,95%CI(0.66,1.45),P0.001]、高血压史[OR=1.58,95%CI(1.10,2.26),P=0.010]、吸烟史[OR=1.71,95%CI(1.12,2.61),P=0.010]、术前血肌酐值[OR=30.26,95%CI(20.17,40.35),P0.000 01]、术前白细胞总数[OR=1.73,95%CI(0.26,3.20),P=0.020]、体外循环时间[OR=25.60,95%CI(21.13,30.08),P0.000 01]、主动脉阻断时间[OR=13.24,95%CI(10.27,16.22),P0.001]、深低温停循环时间[OR=2.58,95%CI(0.86,4.29),P=0.003]、全弓置换术[OR=2.31,95%CI(1.31,4.07),P=0.004]、术中输血量[OR=1.27,95%CI(0.29,2.24),P=0.010]、术后平均动脉压[OR=–2.41,95%CI(–4.59,–0.24),P=0.030]、术后二次出血再次手术[OR=4.19,95%CI(2.04,8.63),P0.001]、术后急性呼吸功能不全[OR=6.61,95%CI(3.21,13.60),P0.001]、术后机械通气时间[OR=48.51,95%CI(21.94,75.09),P0.001]与急性A型主动脉夹层术后AKI相关。结论现有证据表明,性别、体重指数、高血压、吸烟、术前血肌酐水平、术前白细胞数、体外循环时间、主动脉阻断时间、深低温停循环时间、全弓置换术、术中输血量、术后平均动脉压、术后出血二次手术、术后急性呼吸功能不全和术后机械通气时间是急性A型主动脉夹层术后AKI的危险因素。医务人员可结合以上因素加强对急性A型主动脉夹层患者围术期的管理,从而降低术后AKI发生率,改善患者临床预后结局。     

成人良性终末期肝病肝移植术后肾损伤部分危险因素分析

目的回顾性分析成人良性终末期肝病患者行原位肝移植术后发生肾损伤的部分危险因素。方法选择2014年5~12月于我院行同种异体原位肝移植的成人良性终末期肝病患者30例,男18例,女12例,年龄23~68岁,ASAⅢ或Ⅳ级。根据是否发生急性肾损伤(AKI),将患者分为:未发生AKI组(16例)与AKI组(14例)。收集资料包括术前一般情况、手术因素、麻醉因素、是否使用回收式自体输血、术后因素、患者术前肾功能、术后每日尿量、血肌酐(Scr)及尿素氮(BUN)。所有变量单因素分析P0.10纳入Logistic多元回归分析。结果与未发生AKI组比较,AKI组使用回收式自体输血明显减少,输注血小板明显增多,术后需使用升压药维持血压比例明显升高(P0.05)。使用回收式自体输血为保护性因素,OR值为0.058,95%CI为0.005~0.649;输注血小板为危险因素,OR值为10.706,95%CI为1.212~94.963。结论肝移植术使用回收式自体输血,合理输注血小板,可以减少AKI的发生;一旦患者术后需升压药维持血压,会增加AKI发生的可能性。     

AKI网络定义的急性肾损伤在心脏手术后患者中的发生情况及其危险因素和预后分析

目的 了解心脏手术后急性肾损伤（AKI）的发生情况,危险因素及预后。 方法 回顾性分析2004年1月1日至2007年6月30日期间所有在本院行心脏手术的住院患者的临床资料。采用AKI 网络（AKI Network, AKIN）推荐的AKI定义评估心脏手术后AKI的患病率及住院病死率,对术前、术中、术后与AKI发生可能相关的危险因素进行分析。 结果 总共1056例患者中,术后发生AKI者328例,患病率为31.06%。AKI患者的住院病死率显著高于非AKI患者（11.59% 比 0.69%,P < 0.01）。多因素Logistic逐步回归分析显示,高龄（每增加10岁,发生AKI的风险上升1.40倍）、术前高尿酸血症（OR = 1.97）、术前左心功能不全（OR = 2.53）、冠脉旁路移植术（CABG）联合瓣膜手术（OR = 2.79）、手术时间延长（每增加1 h,发生AKI的风险上升1.43倍）、术后循环血容量不足（OR = 11.08）是心脏手术后AKI发生的独立危险因素。 结论 AKI是心脏手术后常见的并发症,AKI患者预后较差。高龄、术前高尿酸血症、术前左心功能不全、CABG联合瓣膜手术、手术时间延长、术后循环血容量不足是心脏手术后AKI发生的独立危险因素。     

1113例心脏瓣膜置换手术后急性肾损伤的临床分析

目的 研究不同类型心脏瓣膜置换手术后急性肾损伤（AKI）的发病情况及其危险因素。 方法 采用前瞻性队列研究。收集本院心外科2009年4月1日至2010年3月31日期间进行心脏瓣膜置换手术患者的临床资料,采用多因素回归方法筛选出各类心脏瓣膜置换患者术后发生AKI的危险因素。AKI诊断标准为48 h内Scr上升≥26.4 μmol/L或较基础值增加≥50%;和（或）尿量<0.5 ml?kg-1?h-1达6 h。结果 1113例瓣膜置换手术患者术后AKI发病率为33.24%,AKI患者住院病死率为6.49%,其死亡风险较非AKI患者增加5.373倍 （P < 0.01）。心脏瓣膜置换伴冠脉搭桥手术术后AKI发病率为75.00%,显著高于其它瓣膜置换手术类型（P < 0.01）。多因素非条件Logistic回归分析表明,年龄（每增加10岁）、男性、术中体外循环时间≥120 min以及心脏瓣膜置换合并冠脉搭桥手术是术后发生AKI的独立危险因素,OR值分别为1.455、2.110、1.768和2.994。 结论 AKI是心脏瓣膜置换手术后常见的严重并发症。心脏瓣膜置换合并冠脉搭桥手术术后更容易发生AKI。高龄、男性、术中体外循环时间≥120 min以及心脏瓣膜置换合并冠脉搭桥手术是心脏瓣膜置换术后发生AKI的独立危险因素。     

Anemia-associated acute kidney injury after cardiac surgery with cardiopulmonary bypass

Objective To investigate the incidence and to evaluate the risk factors of acute kidney injury (AKI) following cardiac surgery with cardiopulmonary bypass (CPB) at general hospitals. Methods A retrospective cohort database study was conducted, involving 233 patients who were scheduled to heart valve surgery or coronary artery bypass grafting (CABG) with CPB technique. Logistic regression was used to screen out the risk factors of AKI after the surgery. Results The study population, with an average age of 57±12 years (age 21 to 83) were investigated, there were 54(23.2%) diabetes patients, 105 (45.1%) hypertension patients, 21 (9%) chronic kidney disease (CKD) patients, and 51 (21.9%) anemia patients. Overall incidence of AKI was 32.2%. The Analysis Result indicates that preoperative CKD, anemia, hypoalbuminemia, left ventricular ejection fraction, intraoperative aortic block time, minimum mean arterial pressure, perioperative infection, and application of vancomycin are risk factors associated with postoperative AKI. Multiariable Logistic regression suggests that basic CKD (OR=9.498, P=0.001), anemia (OR=3.150, P=0.021), the LVEF before surgery (OR=1.733, P=0.045), intraoperative aortic block time (OR=2.227, P=0.026), and white blood cell (OR=3.357, P=0.032) were the independent risk factors of AKI. Conclusions AKI is a common complication following cardiac surgery with CPB. The patients with preoperative renal insufficiency, anemia, long intraoperative aortic block time and higher perioperative white blood cell count are subjected to a higher incidence of AKI. Alleviating patients’ anemia and reducing artery block of extracorporeal circulation time therefore might be potential means to mitigate the risks of AKI after cardiac surgery.     

Correlation analysis between homocysteine level and acute kidney injury after cardiac valve replacement surgery

Objective To investigate the relationship between preoperative serum homocysteine (Hcy) level and acute kidney injury (AKI) after cardiac valve replacement surgery. Methods The data of the inpatients who accepted cardiac valve replacement surgery, age ≥18 years, no renal replacement therapy before surgery, non-renal decompensation and preoperative serum creatinine (Scr)＜178 μmol/L, survival within 48 h after surgery, and with preoperative serum Hcy data in the First Affiliated Hospital of Guangxi Medical University from January 1, 2015 to December 31, 2017 was retrospectively analyzed. AKI was diagnosed in patients whose Scr increased more than 26.5 μmol/L (0.3 mg/dl) within 48 hours or 1.5 times higher than baseline within 7 days after surgery. According to this, patients were divided into AKI group and non-AKI group, and the affecting factors for AKI were compared between the two groups. Multivariate logistic regression was used to analyze the independent influencing factors of AKI. The relationship between serum Hcy level and AKI incidence was analyzed by Spearman correlation analysis. Whether the AKI occurred and serum Hcy levels were used as variables to map the receiver operating characteristic curve (ROC), and was used to assess the value of preoperative serum Hcy level for predicting AKI after cardiac valve replacement surgery. Results A total of 810 subjects were included in the study, including 375 males and 435 females. They were (50±11) years old (19-78 years old). Among them, 329 patients with AKI occurred within 7 days after heart valve replacement, and the incidence rate was 40.6% (male 45.9%, female 36.1%). The serum Hcy level in the AKI group was higher than that in the non-AKI group [(15.74±4.55) μmol/L vs (13.87±3.85) μmol/L, t=6.106, P＜0.01]. Multivariate logistic regression analysis showed age (OR=1.030, 95%CI 1.014-1.045, P＜0.001), extracorporeal circulation time (OR=1.011, 95%CI 1.007-1.016, P＜0.001), Scr (OR=1.014, 95%CI 1.005-1.023, P=0.002), serum Hcy (OR=1.059, 95% CI 1.017-1.103, P=0.006), high level of Hcy (＞13.64 μmol/L) (OR=1.465, 95%CI 1.059-2.027, P=0.021) and moderate to severe hyperhomocystinemia (16≤Hcy≤100 μmol/L) [with normal HHcy (Hcy＜10 μmol/L) as reference, OR=2.180, 95%CI 1.245-3.816, P=0.006] were independent influencing factors of AKI after cardiac valve replacement surgery. Spearman correlation analysis showed that the incidence of postoperative AKI increased with the increase of preoperative serum Hcy level (rs=0.927, P＜0.001). The results of ROC curve showed that the area under the curve of the preoperative serum Hcy level predicting AKI after heart valve replacement was 0.701, and the cutoff value was 13.64 μmol/L, with the sensitivity 61.3%, specificity 70.9%. Conclusions Preoperative serum Hcy level is an influencing factor for AKI after cardiac valve replacement surgery. The higher the level of preoperative serum Hcy, the higher the incidence of AKI after cardiac valve replacement surgery. Patients with preoperative serum Hcy levels＞13.64 μmol/L have an increased risk of AKI after cardiac valve replacement surgery.     

高龄老年人发生持续急性肾损伤危险因素及临床特点分析

目的了解短暂急性肾损伤(AKI)与持续AKI发生率;比较两组AKI患者的临床特征,分析老年人发生持续AKI相关危险因素。 方法回顾性分析2007年1月至2018年12月就诊于解放军总医院国家老年疾病临床医学研究中心≥75岁住院患者的病例资料744例。根据发生AKI后48 h时血肌酐(Scr)恢复情况将患者分为短暂AKI与持续AKI进行分析。采用SPSS 17.0软件进行统计分析。多因素Logistic回归分析老年人发生持续AKI的相关危险因素。 结果744例老年AKI患者中,男性701例,占94.2%,中位年龄88 (84～91)岁。8.3%的患者为短暂AKI (62/744),91.7%的患者为持续AKI (682/744)。两组患者比较,持续AKI患者较短暂AKI患者的高血压病史比例高(72.4%与83.9%, P＝0.041) ,90 d病死率高(37.4%与8.1%, P<0.001)、AKI 3期所占比例高(33.1%与8.1%, P<0.001),确诊时Scr (130.0与116.1 μmol/L, P<0.001)、Scr峰值(147.6与117.9 μmol/L, P<0.001)、血尿素氮(13.1与9.3 mmol/L, P<0.001)、尿酸(368.1与338.3 μmol/L, P＝0.006)、血钠(141与138 mmol/L, P<0.001)水平高。持续AKI患者伴有机械通气(42.5%与12.9%, P<0.001)、低蛋白血症(34.1±5.6与36.1±5.3 g/L, P＝0.006)、贫血(111±22与119±20 g/L, P＝0.009)等情况明显增多。多因素Logistic回归分析显示：Scr峰值(OR＝1.011; 95%CI: 1.004～1.019; P＝0.002)、血钠高(OR＝1.055; 95% CI: 1.015～1.097; P＝0.007)、机械通气(OR＝2.912; 95%CI: 1.334～6.357; P＝0.007)是高龄老年患者发生持续AKI的独立危险因素。 结论高龄老年患者持续AKI的发生率高达92%,早期诊断和治疗危险因素可减少肾脏的持续损伤。     

Analysis of risk factors for progression of acute kidney injury to acute kidney disease

Objective To investigate the risk factors of clinically diagnosed acute kidney injury (AKI) patients progressing to acute kidney disease (AKD). Methods The clinical data of AKI patients admitted to the First Affiliated Hospital of Zhengzhou University from January 1, 2018 to December 31, 2018 were retrospectively analyzed. According to the outcome of the patients, AKI patients were divided into non-acute kidney disease (NAKD) group and AKD group. Clinical characteristics and laboratory data of two groups were compared. The risk factors of AKD in patients with AKI were analyzed by logistic regression, and then the receiver operating characteristic curve (ROC) was drawn to evaluate the predictive value of these risk factors. Results A total of 254 patients with AKI were enrolled, and 186 patients developed AKD with an incidence of 73.2%. The incidences of AKD in stage 1, stage 2 and stage 3 of AKI were 20.0%, 46.7% and 83.5% respectively. Multivariate logistic regression analysis showed increased peak serum creatinine (within 7 days after AKI diagnosis) (OR=2.561, 95%CI 1.584-4.140, P＜0.001), proteinuria (OR=2.952, 95%CI 1.162-7.500, P=0.023) and increased intact parathyroid hormone (OR=1.757, 95%CI 1.104-2.797, P=0.017) were independent risk factors for progression to AKD in patients with AKI. The ROC showed that increased peak serum creatinine (within 7 days after AKI diagnosis) was an important predictor of AKD in patients with AKI (AUC=0.798, P＜0.001). Conclusion Increased peak serum creatinine (within 7 days after AKI diagnosis), proteinuria and increased intact parathyroid hormone are independent risk factors for progression to AKD in patients with AKI, providing new evidences and ideas for clinical preventions and treatments of AKD.     

Postoperative hypoalbuminemia is an independent risk factor for acute kidney injury after cardiac surgery under cardiopulmonary bypass

Objective To investigate the effect of postoperative hypoalbuminemia on acute kidney injury (AKI) after cardiac surgery under cardiopulmonary bypass (CPB). Methods The clinical data of adult patients undergoing cardiac surgery under CPB were retrospectively analyzed. The difference between preoperative and postoperative serum albumin level was compared. The patients were divided into hypoalbuminemia group (≤35 g/L) and non-hypoalbuminemia group (＞35 g/L) according to the lowest serum albumin concentration within 48 hours after surgery. The incidence and severity of postoperative AKI were compared between the two groups. Univariate analysis and binary logistic regression analysis were used to evaluate the effect of postoperative hypoalbuminemia on the incidence of postoperative AKI. Results Among the 749 patients, the serum albumin level after cardiac surgery was significantly lower than that before surgery (Z=-15.739, P＜0.001), and the proportion of patients with hypoalbuminemia increased from 9.6% to 27.6%( χ2=83.516, P＜0.001). Postoperative AKI occurred in 273 patients, including 109 cases (52.7%) in hypoalbuminemia group and 164 cases (30.3%) in non-hypoalbuminemia group. The incidence of AKI in hypoalbuminemia group was significantly higher than that in non-hypoalbuminemia group ( χ2=32.443, P＜0.001), and the severity of AKI in hypoalbuminemia group increased than that in non-hypoalbuminemia group (Z=-2.098, P=0.036), and the time of hospital stay extended (Z=-2.442, P=0.015). After adjusted by gender, age, preoperative hypoalbuminemia, comorbidities (hypertension, hyperuricemia, diabetes mellitus, cerebrovascular disease), renal insufficiency, preoperative heart function, coronary angiography, CPB time, aorta blocking time, type of heart surgery and postoperative hypotension, binary logistic regression analysis revealed that postoperative hypoalbuminemia was an independent risk factor for CPB-associated AKI (OR=2.319, 95%CI 1.586-3.392, P＜0.001). Conclusions AKI is a common complication following cardiac surgery under CPB. Serum albumin after CBP is significantly lower than that before CBP, and postoperative hypoalbuminemia within 48 hours after surgery is an independent risk factor for AKI.     

甘露醇是脑外伤患者发生急性肾损伤的独立危险因素

目的 探讨脑外伤患者发生急性肾损伤(AKI)的危险因素,并评价甘露醇在其中的作用。 方法 回顾性分析2006年1月至2008年12月间复旦大学华山医院神经外科急救中心收治的脑外伤患者AKI的发生情况,AKI诊断采用RIFLE分期标准。采用Logistic回归分析脑外伤患者发生AKI的危险因素,建立脑外伤患者AKI发生的预测模型,并运用接受者操作特性(ROC)曲线及曲线下面积评价该模型对预测脑外伤患者并发AKI的敏感性和特异性。采用倾向性得分匹配法（PSM）进一步分析甘露醇对脑外伤患者发生AKI的影响。 结果 共入选符合标准的脑外伤患者171例,其中AKI组53例,非AKI组118例。患者平均年龄（45.92±16.50）岁。单因素分析结果显示,年龄、高血压、急诊手术、系统性炎性反应综合征（SIRS）、Glasgow昏迷评分、序贯器官衰竭评估（SOFA）评分、SOFA呼吸评分、SOFA凝血评分、SOFA心血管评分、机械通气天数、红细胞悬液累计输注总量、血浆累计输注总量、呋塞米累计总剂量、托拉塞米累计总剂量、甘露醇累计总剂量是脑外伤患者发生AKI的危险因素。多因素Logistic回归分析显示,SOFA评分（OR=1.516,95%CI 1.222~1.881,P < 0.01）、托拉塞米累计总剂量（OR=0.016,95%CI 1.002~1.031,P = 0.016）、甘露醇累计总剂量（OR=2.687,95%CI 1.062~6.800,P = 0.037）是脑外伤患者发生AKI的独立危险因素。运用ROC曲线及曲线下面积评价由SOFA评分、托拉塞米累计总剂量和甘露醇累计总剂量3个变量组成的多因素Logistic回归模型对脑外伤患者发生AKI预测的敏感性和特异性,结果显示ROC曲线下面积为0.901（P < 0.01）,提示该模型对预测脑外伤患者AKI的发生具有良好的敏感性和特异性。倾向性得分匹配法分析结果显示甘露醇总剂量是脑外伤患者发生AKI的独立危险因素。 结论 AKI是脑外伤患者住院期间常见的并发症。SOFA评分、托拉塞米累计总剂量、甘露醇总剂量是脑外伤患者发生AKI的独立危险因素。     

Independent association of preoperative hyperuricemia with acute kidney injury after cardiac surgery with cardiopulmonary bypass

Objective To investigate the impact of preoperative hyperuricemia on acute kidney injury (AKI) after cardiac surgery with cardiopulmonary bypass (CPB). Methods A total of 567 adult patients undergoing cardiac surgery with CPB were enrolled to conduct a retrospective cohort database analysis. The patients were divided into hyperuricemia group and non-hyperuricemia group according to preoperative serum uric acid, and the incidence of AKI in two groups were compared. Binary logistic regression analysis was used to evaluate the relationship between preoperative hyperuricemia and AKI. Results Among 567 patients after cardiac surgery with CPB, hyperuricemia occurred in 303 cases (53.4%), and AKI occurred in 217 cases (38.3%). There was significant difference in the incidence of AKI between hyperuricemia group and non-hyperuricemia group (44.6% vs 31.1%, χ2=10.874, P=0.001). The duration of intensive care unit (ICU) stay and the length of stay were longer in hyperuricemia group than those in non-hyperuricemia group (both P＜0.05). After adjusting for age, gender, comorbidities (hypertension, diabetes mellitus, cerebrovascular disease), preoperative renal function, preoperative heart function, CPB time, intraoperative aortic block time, type of cardiac surgery and postoperative hypotension, binary logistic regression analysis showed that preoperative hyperuricemia was an independent risk factor of AKI after cardiac surgery with CPB (OR=1.912, 95%CI 1.270-2.879, P=0.002). Conclusion AKI is a common complication following cardiac surgery with CPB, and hyperuricemia is independently associated with CPB-associated AKI. Hyperuricemia may be involved in the pathogenesis of AKI, and intervention before cardiac surgery may be beneficial to prevent postoperative AKI.     

Incidence and mortality of acute kidney injury in coronary care unit: a retrospective study from a single center

Objective To evaluate the incidence and mortality of acute kidney injury (AKI) in coronary care unit (CCU), and to identify the risk factors of the incidence of AKI and the mortality of CCU patients. Methods A total of 414 patients in CCU from January 1, 2014 to June 1, 2015 at Zhongnan Hospital of Wuhan University were enrolled. Based on the KDIGO-AKI criteria, these patients were classified into two groups: NAKI group (patients without AKI) and AKI group. Clinical characteristics and laboratory data of two groups were compared. The risk factors of the incidence of AKI and the mortality of CCU patients was analyzed by logistic regression, and then the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of these risk factors. Results (1) Among 414 patients, 136(32.9%) patients fulfilled the criteria for AKI, and 14.0% patients in AKI stage 1, 10.9% in AKI stage 2 and 8.0% in AKI stage 3. (2) The total CCU mortality was 15.0%. Mortality of AKI patients in the CCU was 33.3%, higher than 6.1% in patients without AKI (OR=7.735, 95%CI 4.215-14.196, P＜0.001). The mortality worsened with increasing severity of AKI (22.4% for AKI stage 1 group, 37.8% for AKI stage 2 group, 45.4% for AKI stage 3 group). (3) Anemia (OR=8.274, 95%CI 4.363-15.689), history of chronic illness (OR=2.582, 95%CI 1.400-4.760), APACHEⅡ scores (OR=1.813, 95%CI 1.739-1.895), male (OR=3.666, 95%CI 1.860-7.226) were the independent risk factors for AKI, while the normal mean arterial pressure (MAP) (OR=0.292, 95%CI 0.153-0.556) and normal estimated glomerular filtration rate (eGFR) (OR=0.166, 95%CI 0.090-0.306) are the protective factors for AKI (all P＜0.05). (4) AKI was the most powerful independent factor associated with the mortality of CCU patients (OR=7.050, 95%CI 2.970-16.735, P＜0.001). Other independent risk factors for CCU mortality included history of chronic illness, ejection fraction and APACHEⅡ≥15 scores (all P＜0.05), while the normal MAP and normal eGFR were the protective factors (all P＜0.05). (5) For predicting AKI, eGFR displayed an excellent areas under the ROC curve (AUC=0.815, P＜0.001), and for CCU mortality, APACHEⅡ scores had the highest overall correctness of prediction (AUC=0.757 P＜0.001). Conclusions CCU patients have high morbidity of AKI, which is the most powerful independent factor associated with the increased CCU mortality. The eGFR is the best predictor for AKI, and then through the evaluation of eGFR for CCU patients, we can evaluate high-risk groups, make early interventions and then improve the prognosis of CCU patients.     

Clinical analysis of 1 371 patients with acute kidney injury after acute myocardial infarction

Objective To investigate the risk factors of acute kidney injury (AKI) in patients after acute myocardial infarction (AMI). Methods A total of 1 371 adult patients diagnosed AMI in the First People's Hospital of Changzhou from January 2008 to December 2012 were analyzed retrospectively. AKI was defined according to the 2012 KDIGO AKI criteria. Based on the occurrence of AKI, the patients were divided into AKI group and non-AKI group. According to the AKI timing, the patients were divided into subgroups including conservative treatment groups, coronary angiography(CAG) groups and coronary artery bypass grafting (CABG) groups, respectively. Related risk factors of AKI were analyzed by univariate and multivariate logistic regression. Results Of the 1 371 patients,410(29.9%) developed AKI. Compared to the non-AKI group, in-hospital mortality increased significantly in the AKI group (17.1% vs 3.9%, χ2=68.0, P＜0.001). Multifactor retrospective analysis showed that decreased baseline eGFR (OR=2.049, 95%CI: 1.246-3.370), increased fasting plasma glucose(FPG) (OR=1.070, 95%CI: 1.018-1.124), diuretics (OR=1.867, 95%CI: 1.220-2.856) and Killip class 4 status (OR=1.362, 95%CI: 1.059-3.170) were all independent risk factors of AKI, while increased DBP on admission was a protective factor (OR=0.986, 95%CI: 0.974-0.998) for the conservative management group. Decreased baseline eGFR (OR=2.371, 95%CI: 1.500-3.747), increased FPG(OR=1.009, 95%CI: 1.005-1.012), diuretics (OR=1.674, 95%CI: 1.042-2.690), intraoperative hypotension (OR=2.276, 95%CI: 1.324-3.575) and acute infection (OR=1.678, 95%CI: 1.023-2.754) were independent risk factors of AKI for the CAG group. Decreased baseline eGFR (OR=2.246, 95%CI:1.340-3.981), increased FPG (OR=1.059, 95%CI: 1.018-1.124), diuretics (OR=1.723, 95%CI: 1.122-2.650), and low cardiac output syndrome after operation (OR=2.331, 95%CI: 1.277-3.286) were independent risk factors of AKI for CABG group. Conclusions AKI is a common complication and associated with increased mortality after AMI. Decreased baseline renal function, increased FPG and diuretics were common independent risk factors of AKI after AMI.     

老年脓毒症相关急性肾损伤后肾功能恢复及危险因素分析

目的了解老年脓毒症相关急性肾损伤(sepsis-associated acute kidney injury, SA-AKI)患者的肾功能恢复率、临床特点及危险因素。 方法回顾性分析2018年1月至2019年12月就诊于解放军总医院国家老年疾病临床医学研究中心≥75岁的SA-AKI患者的临床资料。根据出院时肌酐(serum creatinine,Scr)恢复情况,患者分为恢复组(出院时Scr≤125%基线值)和未恢复组(出院时Scr>125%基线值)。AKI定义和诊断标准采用2012年改善全球肾脏病预后组织(Kidney Disease: Improving Global Outcomes,KDIGO)制定的标准。持续型AKI定义为AKI发生48 h时Scr无下降(>基线Scr水平)。 结果192例患者中位年龄为87(84～90)岁,男性183例,占95.3%。患者出院时21.9%(42/192)患者肾功能未恢复,78.1%(150/192)肾功能恢复。肾功能恢复组与未恢复组相比,性别比例(P<0.05)、基线Scr(P<0.001)和基础eGFR(P<0.001)差异有统计学意义。肾功能未恢复组患者AKI确诊时Scr(P<0.05)、Scr峰值(P<0.001)水平较高,肾脏替代治疗(P<0.05)和机械通气(P<0.001)需要率明显增加,持续型AKI所占比例高(P<0.001)。多因素Logistic回归分析显示两组在基础eGFR(70～79: OR＝0.258,95%CI：0.088～0.757,P<0.05;80～89: OR＝0.132,95%CI：0.041～0.421,P＝0.001;≥90：OR＝0.096,95%CI：0.015～0.627,P＝0.014)、机械通气(OR＝6.715;95%CI：2.665～16.918;P<0.001)和持续型AKI(OR＝6.706;95%CI：2.741～16.404;P<0.001)等方面差异显著。 结论高龄老年SA-AKI患者肾功能大多数可恢复,基础eGFR升高是高龄老年SA-AKI患者肾功能恢复的保护因素,机械通气和持续型AKI是高龄老年SA-AKI患者肾功能恢复的危险因素。