Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: A prospective cohort study
Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: A prospective cohort study
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DOI：
10.1097/01.asn.0000130340.93930.dd
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发表时间：
2004-06-01
影响因子：
13.6
通讯作者：
Hiesmayr, M
中科院分区：
文献类型：
--
作者：
Lassnigg, A;Schmidlin, D;Hiesmayr, M
急性肾衰竭增加心脏手术后死亡的风险。然而，尚不清楚肾功能的更细微变化是否会影响结局。因此，分析了术后血清肌酐微小变化与死亡率之间的相关性，独立于其他已确定的围手术期风险指标。在4118例接受心脏和胸主动脉手术的患者的前瞻性队列研究中，分析了术后48天内血清肌酐变化对30天死亡率的影响。考克斯回归用于校正各种已建立的人口统计学术前风险指标、术中参数和术后并发症。在2441例血清肌酐降低的患者中，早期死亡率为2.6%，而术后血清肌酐值升高的患者的早期死亡率为8.9%。大幅度降低的患者（DeltaCrea < -0.3 mg/dl）显示30天死亡率逐渐增加（16/199 [8%]）。血清肌酐最大值降至-0.3 mg/dl的患者死亡率最低（47/2195 [2.1%]）;血清肌酐保持不变或升高至0.5 mg/dl的患者死亡率升高至6%。肌酐升高≥ 0.5 mg/dl的患者死亡率最高（65/200 [32.5%]）。对于所有组，在多变量分析中死亡率的增加仍然显著，包括术后肾脏替代治疗。心脏和胸主动脉手术后，血清肌酐轻微下降的患者30天死亡率最低。血清肌酐的任何轻微升高或显著降低均与生存率的显著降低相关。
Acute renal failure increases risk of death after cardiac surgery. However, it is not known whether more subtle changes in renal function might have an impact on outcome. Thus, the association between small serum creatinine changes after surgery and mortality, independent of other established perioperative risk indicators, was analyzed. In a prospective cohort study in 4118 patients who underwent cardiac and thoracic aortic surgery, the effect of changes in serum creatinine within 48 It postoperatively on 30-d mortality was analyzed. Cox regression was used to correct for various established demographic preoperative risk indicators, intraoperative parameters, and postoperative complications. In the 2441 patients in whom serum creatinine decreased, early mortality was 2.6% in contrast to 8.9% in patients with increased postoperative serum creatinine values. Patients with large decreases (DeltaCrea < -0.3 mg/dl) showed a progressively increasing 30-d mortality (16 of 199 [8%]). Mortality was lowest (47 of 2195 [2.1%]) in patients in whom serum creatinine decreased to a maximum of -0.3 mg/dl; mortality increased to 6% in patients in whom serum creatinine remained unchanged or increased up to 0.5 mg/dl. Mortality (65 of 200 [32.5%]) was highest in patients in whom creatinine increased greater than or equal to 0.5 mg/dl. For all groups, increases in mortality remained significant in multivariate analyses, including postoperative renal replacement therapy. After cardiac and thoracic aortic surgery, 30-d mortality was lowest in patients with a slight postoperative decrease in serum creatinine. Any even minimal increase or profound decrease of serum creatinine was associated with a substantial decrease in survival.