Post-operative acute kidney injury and five-year risk of death, myocardial infarction, and stroke among elective cardiac surgical patients: a cohort study.
Post-operative acute kidney injury and five-year risk of death, myocardial infarction, and stroke among elective cardiac surgical patients: a cohort study.
复制标题
DOI：
10.1186/cc13158
复制
发表时间：
2013-12-12
期刊：
影响因子：
--
通讯作者：
Christiansen CF
中科院分区：
文献类型：
--
作者：
Hansen MK;Gammelager H;Mikkelsen MM;Hjortdal VE;Layton JB;Johnsen SP;Christiansen CF
急性肾损伤（阿基）对长期临床结局的预后影响仍存在争议。我们研究了择期心脏手术并发阿基后5年死亡、心肌梗死和卒中的风险。我们在没有严重慢性肾脏疾病和/或既往心脏或肾脏移植手术的成人择期心脏手术患者中进行了一项队列研究，使用基于人群的登记数据。根据急性肾损伤网络（AKIN）标准，阿基定义为血清肌酐较基线水平升高50%，48小时内急性肌酐升高≥26.5 μmol/L（0.3 mg/dL），和/或术后5天内开始肾脏替代治疗。我们从术后第五天开始对患者进行随访，直到五年内发生心肌梗死、中风或死亡。通过累积发生率方法计算5年风险，并与调整倾向评分的考克斯比例风险回归模型的风险比（HR）进行比较。1，030名患者中共有287名（27.9%）出现阿基。AKI患者的五年死亡风险为26.5%（95%CI：21.2至32.0），非阿基患者的五年死亡风险为12.1%（95%CI：10.0至14.7）。相应的死亡校正HR为1.6（95% CI：1.1 - 2.2）。AKI患者的5年心肌梗死风险为5.0%（95% CI：2.9 - 8.1），无阿基患者的5年心肌梗死风险为3.3%（95% CI：2.1 - 4.8）。AKI患者的5年卒中风险为5.0%（95% CI：2.8 - 7.9），无阿基患者的5年卒中风险为4.2%（95% CI：2.9 - 5.8）。心肌梗死的校正HR为1.5（95% CI：0.7 - 3.2），卒中的校正HR为0.9（95% CI：0.5 - 1.8）。择期心脏手术后5天内发生的阿基与5年死亡率增加和心肌梗死风险增加相关，但无统计学意义。未发现与中风风险相关。
The prognostic impact of acute kidney injury (AKI) on long-term clinical outcomes remains controversial. We examined the five-year risk of death, myocardial infarction, and stroke after elective cardiac surgery complicated by AKI. We conducted a cohort study among adult elective cardiac surgical patients without severe chronic kidney disease and/or previous heart or renal transplant surgery using data from population-based registries. AKI was defined by the Acute Kidney Injury Network (AKIN) criteria as a 50% increase in serum creatinine from baseline level, acute creatinine rise of ≥26.5 μmol/L (0.3 mg/dL) within 48 hours, and/or initiation of renal replacement therapy within five days after surgery. We followed patients from the fifth post-operative day until myocardial infarction, stroke or death within five years. Five-year risk was computed by the cumulative incidence method and compared with hazards ratios (HR) from a Cox proportional hazards regression model adjusting for propensity score. A total of 287 (27.9%) of 1,030 patients developed AKI. Five-year risk of death was 26.5% (95% CI: 21.2 to 32.0) among patients with AKI and 12.1% (95% CI: 10.0 to 14.7) among patients without AKI. The corresponding adjusted HR of death was 1.6 (95% CI: 1.1 to 2.2). Five-year risk of myocardial infarction was 5.0% (95% CI: 2.9 to 8.1) among patients with AKI and 3.3% (95% CI: 2.1 to 4.8) among patients without AKI. Five-year risk of stroke was 5.0% (95% CI: 2.8 to 7.9) among patients with AKI and 4.2% (95% CI: 2.9 to 5.8) among patients without AKI. Adjusted HRs were 1.5 (95% CI: 0.7 to 3.2) of myocardial infarction and 0.9 (95% CI: 0.5 to 1.8) of stroke. AKI, within five days after elective cardiac surgery, was associated with increased five-year mortality and a statistically insignificant increased risk of myocardial infarction. No association was seen with the risk of stroke.
登录
查看更多内容
DOI：
10.1097/01.asn.0000064946.94590.46
发表时间：
2003-06-01
影响因子：
13.6
作者：
Kelly, KJ
通讯作者：
Kelly, KJ
影响因子：
5.9
作者：
Chertow, GM;Levy, EM;Daley, J
通讯作者：
Daley, J
影响因子：
2.3
作者：
Lindsay, J;Apple, S;Waksman, R
通讯作者：
Waksman, R
影响因子：
3.4
作者：
Nashef, SAM;Rogues, F;Salamon, R
通讯作者：
Salamon, R
DOI：
10.3265/nefrologia.pre2011.oct.11102
发表时间：
2012-01-01
期刊：
Nefrología (Madrid)
影响因子：
--
作者：
Candela-Toha, A.M.;Recio-Vázquez, M.;Tenorio, T.
通讯作者：
Tenorio, T.