Nadir Hematocrit on Bypass and Rates of Acute Kidney Injury: Does Sex Matter?
Nadir Hematocrit on Bypass and Rates of Acute Kidney Injury: Does Sex Matter?
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DOI：
10.1016/j.athoracsur.2015.05.080
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发表时间：
2015-11-01
影响因子：
4.6
通讯作者：
Likosky, Donald S.
中科院分区：
文献类型：
--
作者：
Ellis, Michelle C.;Paugh, Theron A.;Likosky, Donald S.
背景报告将心肺转流中的最低红细胞压积（Hct）与肾功能不全的发生联系起来。最近的文献表明，女性虽然更经常暴露于较低的最低Hct，但术后肾功能不全的风险较低。我们评估了这种关系是否在一个大型多中心注册。我们对2010年至2014年期间在密歇根州26家机构接受心脏手术的15，221名非透析依赖患者（10，376名男性，68.2%; 4，845名女性，31.8%）进行了一项前瞻性观察性研究。我们计算了体外循环期间最低Hct与2期或3期急性肾损伤（阿基）之间的粗OR和校正OR，并测试了性别和最低Hct的相互作用。阿基的预测概率分别为男性和女性绘制。16.6%的患者发生最低Hct低于21%，但男性（9.5%）低于女性（31.9%; p < 0.001）。2.7%的患者发生急性肾损伤，男性和女性之间的绝对差异较小（2.6% vs 3.0%，p = 0.20）。性别和最低Hct之间存在显著的相互作用（p = 0.009）。男性患者的最低Hct对阿基的影响（最低Hct每降低1个单位的校正比值比为1.10，95%置信区间：1.05 - 1.13）强于女性患者（校正比值比为1.01，95% CI：0.96，1.06）。较低的最低Hct与阿基风险增加相关，男性的影响似乎比女性更强。尽管这些结果表明需要限制暴露于较低的最低Hct，但对这种相关性的机制的理解仍不确定，尤其是对于男性患者。(C)2015年美国胸外科医师协会
Background. Reports have associated nadir hematocrit (Hct) on cardiopulmonary bypass with the occurrence of renal dysfunction. Recent literature has suggested that women, although more often exposed to lower nadir Hct, have a lower risk of postoperative renal dysfunction. We assessed whether this relationship held across a large multicenter registry.Methods. We undertook a prospective, observational study of 15,221 nondialysis-dependent patients (10,376 male, 68.2%; 4,845 female, 31.8%) undergoing cardiac surgery between 2010 and 2014 across 26 institutions in Michigan. We calculated crude and adjusted OR between nadir Hct during cardiopulmonary bypass and stage 2 or 3 acute kidney injury (AKI), and tested the interaction of sex and nadir Hct. The predicted probability of AKI was plotted separately for men and women.Results. Nadir Hct less than 21% occurred among 16.6% of patients, although less commonly among men (9.5%) than women (31.9%; p < 0.001). Acute kidney injury occurred among 2.7% of patients, with small absolute differences between men and women (2.6% versus 3.0%, p = 0.20). There was a significant interaction between sex and nadir Hct (p = 0.009). The effect of nadir Hct on AKI was stronger among male patients (adjusted odds ratio per 1 unit decrease in nadir Hct 1.10, 95% confidence interval: 1.05 to 1.13) than female patients (adjusted odds ratio 1.01, 95% CI: 0.96, 1.06).Conclusions. Lower nadir Hct was associated with an increased risk of AKI, and the effect appears to be stronger among men than women. Understanding of the mechanism underlying this association remains uncertain, although these results suggest the need to limit exposure to lower nadir Hct, especially for male patients. (C) 2015 by The Society of Thoracic Surgeons