Trends in acute renal failure associated with coronary artery bypass graft surgery in the United States
Trends in acute renal failure associated with coronary artery bypass graft surgery in the United States
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DOI：
10.1097/01.ccm.0000282079.05994.57
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发表时间：
2007-10-01
影响因子：
8.8
通讯作者：
Stafford-Smith, Mark
中科院分区：
文献类型：
--
作者：
Swaminathan, Madhav;Shaw, Andrew D.;Stafford-Smith, Mark
Objective.急性肾功能衰竭仍然是冠状动脉旁路移植术的主要并发症，与住院死亡率密切相关。基于在其他临床环境中的类似观察，我们检验了以下假设：在美国，冠状动脉旁路移植术相关的急性肾功能衰竭的诊断正在增加。观察性队列研究。全国住院病人样本数据库被用来检验假设。该数据库包含20%的美国医院的出院信息。患者：1988年至2003年期间因冠状动脉旁路移植术而编码的医院出院信息包括研究人群;那些也因急性肾衰竭而编码的患者形成了感兴趣的子集。干预措施：无。测量和主要结果。构建多变量回归模型，包括调整风险因素和合并症，以确定手术年与急性肾功能衰竭诊断和死亡率之间的关系。在研究期间，急性肾衰竭诊断的发生率从1.1%显著增加至4.1%（p <0.0001）。需要透析的急性肾衰竭病例比例从15.8%降至8.7%（p <0.0001）。尽管共病疾病负担增加，急性肾衰竭亚组的死亡率从39.5%下降到17.9%（p <0.0001）。出院后需要特殊护理的急性肾功能衰竭幸存者的比例从35.5%增加到64.5%（p <0.0001）。结论：我们的研究结果表明，观察到的急性肾功能衰竭诊断率的增加可能部分归因于急性肾功能衰竭诊断的限制性标准较少，与其他临床环境中观察到的急性肾功能衰竭模式一致。虽然透析的需要是诊断急性肾衰竭的一个相对明确的基准，但使用替代标准来定义这种疾病已变得越来越普遍，可能有助于提高诊断率。我们的结论是，从1988年到2003年，全国范围内与冠状动脉旁路移植术相关的急性肾功能衰竭的趋势显著增加。尽管死亡率下降，但急性肾衰竭仍然是医疗资源的负担。
Objective. Acute renal failure remains a major complication of coronary artery bypass graft surgery that is strongly associated with in-hospital mortality. Based on similar observations in other clinical settings, we tested the hypothesis that the diagnosis of acute renal failure associated with coronary artery bypass graft surgery is increasing in the United States.Design. Observational cohort study.Setting:. The Nationwide Inpatient Sample database was used to test the hypothesis. This database contains discharge information from 20% of U.S. hospitals.Patients: Hospital discharges coded for coronary artery bypass graft surgery from 1988 to 2003 comprised the study population; those also coded for acute renal failure formed the subset of interest.Interventions: None.Measurements and Main Results. Multivariable regression models were constructed, including adjustment for risk factors and comorbidities, to identify the relationship between year of surgery and diagnosis of acute renal failure and mortality. The incidence of acute renal failure diagnosis increased significantly during the study period from 1.1% to 4.1% (p < .0001). The proportion of acute renal failure cases that required dialysis decreased from 15.8% to 8.7% (p < .0001). Despite an increase in comorbid disease burden, mortality in the acute renal failure subgroup declined from 39.5% to 17.9% (p < .0001). The percentage of acute renal failure survivors with postdischarge special-care requirements increased from 35.5% to 64.5% (p < .0001).Conclusions: Our findings suggest that the observed increase in acute renal failure diagnosis rates may be partly attributable to less restrictive criteria for acute renal failure diagnosis, consistent with acute renal failure patterns observed in other clinical settings. Although the need for dialysis is a relatively clear benchmark for diagnosing acute renal failure, use of alternate criteria to define this disorder has become more common, perhaps contributing to higher diagnosis rates. We conclude that the nationwide trend of acute renal failure associated with coronary artery bypass graft surgery has significantly increased from 1988 to 2003. Despite declining mortality, acute renal failure remains a burden on healthcare resources.