Effect of preoperative renal function on long-term survival after cardiac surgery
Effect of preoperative renal function on long-term survival after cardiac surgery
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DOI：
10.1016/j.jtcvs.2012.06.037
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发表时间：
2013-07-01
影响因子：
6
通讯作者：
Fraser, John F.
中科院分区：
文献类型：
--
作者：
Dhanani, Jayesh;Mullany, Daniel V.;Fraser, John F.
目的：研究目的是探讨肾功能衰竭对心脏手术患者中期生存的影响。方法：2002年1月1日至2005年12月1日，所有18岁及以上接受冠状动脉搭桥术、瓣膜手术、胸主动脉手术或两者联合手术的患者纳入研究。数据来自心脏外科和重症监护数据库。使用匹配算法，从国家死亡指数中获得死亡日期。采用肾脏疾病简化医学饮食公式计算估算的肾小球滤过率，并对患者进行分层。术前肾功能对死亡时间间隔的影响采用Cox回归分析（有和没有三次样条和多项式回归）确定。使用Kaplan-Meier积限法描述长期生存。结果：本研究共纳入5297例患者。所有患者术后平均2.9年（范围，1-5）获得生命体征。精算1年生存率为96% 1%，3年生存率为92%±1%。严重肾功能不全组早期死亡率最高；然而，与其他组相比，透析依赖性肾衰竭组的死亡率随着时间的推移而增加。死亡风险最低（死亡间隔时间最长）的肾小球滤过率估计约为90 mL/min/1.73 m(2)。结论：我们的研究结果表明，术前肾功能障碍是心脏手术患者长期死亡率的独立预测因素。
Objectives: The study objective was to investigate the effect of renal failure on intermediate-term survival in cardiac surgery patients.Methods: All patients aged 18 years or older undergoing coronary artery bypass grafting, valvular surgery, thoracic aortic surgery, or a combination of these from January 1, 2002 to December 1, 2005 were included. Data were obtained from the cardiac surgery and intensive care databases. Using a matching algorithm, the date of death was obtained from the National Death Index. The simplified Medical Diet for Renal Disease formula was used to calculate the estimated glomerular filtration rate, and the patients were stratified accordingly. An estimation of the effect of the preoperative renal function on the interval to death was determined using Cox regression analysis with and without cubic splines and polynomial regression. The long-term survival was described using the Kaplan-Meier product limit method.Results: A total of 5297 patients were included in the present study. The vital status of all patients was obtained at a mean of 2.9 years (range, 1-5) postoperatively. The actuarial 1-year survival rate was 96% 1%, and the 3-year survival rate was 92% +/- 1%. The greatest early mortality occurred in the severe renal dysfunction group; however, the dialysis-dependent renal failure group showed increased mortality over time compared with the other groups. The lowest risk of death (longest interval to death) occurred with an estimated glomerular filtration rate of approximately 90 mL/min/1.73 m(2).Conclusions: The results of our study have shown that preoperative renal dysfunction is an independent predictor of long-term mortality in cardiac surgery patients.