Association of Pre-Operative Albuminuria with Post-Operative Outcomes after Coronary Artery Bypass Grafting.
Association of Pre-Operative Albuminuria with Post-Operative Outcomes after Coronary Artery Bypass Grafting.
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DOI：
10.1038/srep16458
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发表时间：
2015-11-09
影响因子：
4.6
通讯作者：
Kovesdy CP
中科院分区：
文献类型：
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作者：
George LK;Molnar MZ;Lu JL;Kalantar-Zadeh K;Koshy SK;Kovesdy CP
冠状动脉旁路移植术（CABG）手术后对术后结局的影响尚不清楚。在2006年10月1日至2012年9月28日期间在美国退伍军人事务部（VA）医院接受CABG的17，812例患者中，我们确定了5，968例术前尿白蛋白-肌酐比值（UACR）测量值。我们研究了UACR<30、30-299和>=300 mg/g与30/90/180/365天和总体全因死亡率、住院时间>10天以及急性肾损伤（阿基）的相关性。平均± SD基线年龄和eGFR分别为66 ± 8岁和77 ± 19 ml/min/1.73 m2。788例患者（13.2%）在中位随访3.2年期间死亡，26.8%的患者在CABG后30天内发生阿基（23.1%-1期; 2.9%-2期; 0.8%-3期）。UACR < 30 mg/g、30-299 mg/g和≥300 mg/g组的中位住院时间分别为8天（IQR：6-13天）、10天（IQR：7-14天）和12天（IQR：8-19天）。与UACR<30 mg/g相比，较高的UACR使90天、180天和365天死亡率高72 - 85%（UACR≥300 vs.<30 mg/g的比值比和95%置信区间分别为：1.72（1.01-2.95）; 1.85（1.14-3.01）; 1.74（1.15-2.61））。较高的UACR还与显著较长的住院时间和所有阶段阿基的较高发生率相关。较高的UACR与显著较高的死亡率、较长的CABG后住院时间和较高的阿基发生率相关。
The effect on post-operative outcomes after coronary artery bypass graft(CABG) surgery is not clear. Among 17,812 patients who underwent CABG during October 1,2006-September 28,2012 in any Department of US Veterans Affairs(VA) hospital, we identified 5,968 with available preoperative urine albumin-creatinine ratio(UACR) measurements. We examined the association of UACR<30, 30–299 and >=300 mg/g with 30/90/180/365-day and overall all-cause mortality, and hospitalization length >10 days, and with acute kidney injury(AKI). Mean ± SD baseline age and eGFR were 66 ± 8 years and 77 ± 19 ml/min/1.73 m2, respectively. 788 patients(13.2%) died during a median follow-up of 3.2 years, and 26.8% patients developed AKI(23.1%-Stage 1; 2.9%-Stage 2; 0.8%-Stage 3) within 30 days of CABG. The median lengths of stay were 8 days(IQR: 6–13 days), 10 days(IQR: 7–14 days) and 12 days(IQR: 8–19 days) for groups with UACR < 30 mg/g, 30–299 mg/g and ≥300 mg/g, respectively. Higher UACR conferred 72 to 85% higher 90-, 180-, and 365-day mortality compared to UACR<30 mg/g (odds ratio and 95% confidence interval for UACR≥300 vs. <30 mg/g: 1.72(1.01–2.95); 1.85(1.14–3.01); 1.74(1.15–2.61), respectively). Higher UACR was also associated with significantly longer hospitalizations and higher incidence of all stages of AKI. Higher UACR is associated with significantly higher odds of mortality, longer post-CABG hospitalization, and higher AKI incidence.