心脏术后并发急性肾损伤的危险因素及预后分析

目的分析心脏术后发生急性肾损伤(CSA-AKI)的危险因素以及预后情况。方法 2017年9月至2019年5月期间连续筛选南京市第一医院重症医学科收治的2 041例成年心血管外科术后患者。根据患者术后有无并发AKI分为AKI组和非AKI组。比较两组患者一般资料和临床预后情况,并采用逻辑回归分析术后患者发生AKI的危险因素。结果 2 041例成年患者CSA-AKI有397例(19.5%)。多因素逻辑回归分析显示,术前血肌酐水平增高(OR=1.04,95%CI:1.02~1.07)、血尿酸水平增高(OR=1.01,95%CI:1.00~1.02)、中性粒细胞明胶酶相关脂蛋白(NGAL)增高(OR=1.02, 95%CI:1.01~1.02)和血红蛋白降低(OR=0.98,95%CI:0.96~1.00),术中红细胞输注量增多(OR=1.97,95%CI:1.42~2.73),术后24 h内血乳酸水平增高(OR=1.88,95%CI:1.56~2.27)和血管活性药物评分增高(OR=1.30,95%CI:1.24~1.37)与术后AKI显著相关。在CSA-AKI患者中,机械通气时间、ICU滞留时间和住院时间显著延长、多器官功能衰竭综合征比例、连续性肾脏替代治疗比例、住院病死率以及ICU病死率均显著升高。结论 CSA-AKI患者的危险因素包括术前血肌酐、血尿酸、血红蛋白及NGAL水平、术中红细胞输注量、术后血乳酸和血管活性药物评分,而且该类患者病死率更高,预后更差。

Risk factors and prognosis of postoperative acute kidney injury after cardiac surgery

Objective To analyze the risk factors and prognosis of postoperative acute kidney injury(AKI) after cardiac surgery. Methods Two thousand and forty one adult patients with cardiac surgery admitted to Department of Intensive Care Unit in Nanjing First Hospital from September 2017 and May 2019 were enrolled. Patients were divided into AKI group and non-AKI group according to whether AKI occurred. The general data and clinical outcomes of the two groups were compared, and multivariate logistic regression analysis was used to analyze the risk factors of postoperative AKI after cardiovascular surgery. Results A total of 2041 adult patients with cardiovascular surgery were enrolled, and 397 patients(19.5%) developed AKI. Multivariate logistic regression analysis showed 7 independent risk factors for postoperative AKI: preoperative serum creatinine(OR=1.04, 95%CI: 1.02-1.07), hemoglobin(OR=0.98, 95%CI: 0.96-1.00), serum uric acid(OR=1.01, 95%CI: 1.00-1.02), neutrophil gelatinase associated lipocalin(OR=1.02, 95%CI: 1.01-1.02), intraoperative red blood cell units(OR=1.97, 95%CI: 1.42-2.73), postoperative lactate(OR=1.88, 95%CI: 1.56-2.27) and Vasoactive-Inotropic Score(OR=1.30, 95%CI: 1.24-1.37). In patients with CSA-AKI, there were longer mechanical ventilation time, hospital stay, ICU stay, higher indicence of multiple organ dysfunction syndrome, continuous renal replacement therapy, hospital mortality, and ICU mortality. Conclusion Risk factors of AKI after cardiovascular surgery included preoperative serum creatinine, hemoglobin, serum uric acid, neutrophil gelatinase associated lipocalin, intraoperative red blood cell units, postoperative lactate, and Vasoactive-Inotropic Score. Furthermore, patients with postoperative AKI were more likely to have higher morbidity and mortality.