Independent association between acute renal failure and mortality following cardiac surgery
Independent association between acute renal failure and mortality following cardiac surgery
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DOI：
10.1016/s0002-9343(98)00058-8
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发表时间：
1998-04-01
影响因子：
5.9
通讯作者：
Daley, J
中科院分区：
文献类型：
--
作者：
Chertow, GM;Levy, EM;Daley, J
目得：确定需要透析的急性肾功能衰竭与心脏手术后的手术死亡率之间是否存在独立的相关性。42号，对1987年至1994年间在43个退伍军人事务部医疗中心接受冠状动脉搭桥术或心脏瓣膜手术的773名患者进行了评估，以确定足以需要透析的急性肾衰竭与手术死亡率，有和没有调整合并症和术后并发症。结果：460例（1.1%）患者发生急性肾功能衰竭。这些患者的总体手术死亡率为63.7%，而无此并发症的患者为4.3%。死亡的未校正OR为39（95% CI 32 - 48）。校正与急性肾衰竭发生相关的共病因素后（手术类型、基线肾功能、术前主动脉内球囊反搏、既往心脏手术、NYHA IV级状态、外周血管疾病、肺部啰音、左心室射血分数低于35%、慢性阻塞性肺疾病、收缩压以及收缩压与手术类型的乘积），OR为27（95%CI 22 ~ 34）。进一步调整了与手术死亡率独立相关的7种术后并发症（低心排血量、心脏骤停、围手术期心肌梗死、机械通气时间延长、因出血或重复心肺转流术而再次手术、卒中或昏迷以及纵隔炎）。校正合并症和术后并发症与急性肾功能衰竭相关的OR为7.9（95%CI 6 - 10）。结论：急性肾功能衰竭与心脏手术后的早期死亡率独立相关，即使校正合并症和术后并发症后也是如此。迫切需要采取干预措施来预防或改善这种情况的治疗。(C)1998年，Excerpta Medica，Inc.
PURPOSE: To determine whether there is an independent association of acute renal failure requiring dialysis with operative mortality after cardiac surgery.PATIENTS AND METHODS: The 42,773 patients who underwent coronary artery bypass or valvular heart surgery at 43 Department of Veterans Affairs Medical Centers between 1987 and 1994 were evaluated to determine the association between acute renal failure sufficient to require dialysis and operative mortality, with and without adjustment for comorbidity and postoperative complications. Crude and adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were derived from logistic regression analysis.RESULTS: Acute renal failure occurred in 460 (1.1 %) patients. Overall operative mortality was 63.7% in these patients, compared with 4.3% in patients without this complication. The unadjusted OR for death was 39 (95% CI 32 to 48). After adjustment for comorbid factors related to the development of acute renal failure (surgery type, baseline renal function, preoperative intraaortic balloon pump, prior heart surgery, NYHA class IV status, peripheral vascular disease, pulmonary rales, left ventricular ejection fraction below 35%, chronic obstructive pulmonary disease, systolic blood pressure, and the cross-product of systolic blood pressure and surgery type), the OR was 27 (95% CI 22 to 34). Further adjustment was made for seven postoperative complications (low cardiac output, cardiac arrest, perioperative myocardial infarction, prolonged mechanical ventilation, reoperation for bleeding or repeat cardiopulmonary bypass, stroke or coma, and mediastinitis), that were independently associated with operative mortality. The OR adjusted for comorbidity and postoperative complications associated with acute renal failure was 7.9 (95% CI 6 to 10).CONCLUSIONS: Acute renal failure was independently associated with early mortality following cardiac surgery, even after adjustment for comorbidity and postoperative complications. Interventions to prevent or improve treatment of this condition are urgently needed. (C) 1998 by Excerpta Medica, Inc.