The Pattern of Longitudinal Change in Serum Creatinine and 90-Day Mortality After Major Surgery.
The Pattern of Longitudinal Change in Serum Creatinine and 90-Day Mortality After Major Surgery.
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大手术后血清肌酐和 90 天死亡率的纵向变化模式。
DOI：
10.1097/sla.0000000000001362
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发表时间：
2016-06
影响因子：
9
通讯作者：
Bihorac A
中科院分区：
文献类型：
--
作者：
Korenkevych D;Ozrazgat-Baslanti T;Thottakkara P;Hobson CE;Pardalos P;Momcilovic P;Bihorac A
使用肌酐纵向变化模式计算死亡率风险，该风险可解释术后肾功能障碍的严重程度和恢复情况。尽管人们越来越认识到急性肾损伤（AKI）后肾脏恢复的重要性，但导致纵向肌酐变化和死亡率的复杂关联尚未得到充分描述。我们使用常规收集的 46,299 名接受大手术的成年患者的临床信息来开发针对血清肌酐时间序列的非线性进行优化的多变量概率模型，以计算 90 天死亡率的风险函数。我们进行了 70/30 交叉验证分析来评估模型的准确性。所有肌酐时间序列都表现出与九十天死亡率相关的非线性风险函数，并且将它们与其他临床因素相结合改善了模型的辨别力。对于任何给定严重程度的 AKI，肾脏完全恢复的患者（表现为排出肌酐恢复至基线值）与部分恢复的患者相比，入院 90 天内死亡的几率显着降低。然而，对于任何严重程度的 AKI，即使肾功能完全恢复也不能完全减轻死亡几率的增加，因为与无 AKI 的患者相比，轻度 AKI 和肾功能完全恢复的患者的死亡几率仍然显着增加（比值比 1,48（95% 置信区间 1.30-1.68）。我们证明了肾功能不全的严重程度和恢复与大手术后 90 天死亡率之间的非线性关系。我们开发了一种易于应用的计算机算法来计算这种复杂的关系。
Calculate mortality risk that accounts for both severity and recovery of postoperative kidney dysfunction using the pattern of longitudinal change in creatinine. Although the importance of renal recovery after acute kidney injury (AKI) is increasingly recognized, the complex association that accounts for longitudinal creatinine changes and mortality is not fully described. We used routinely collected clinical information for 46,299 adult patients undergoing major surgery to develop a multivariable probabilistic model optimized for non-linearity of serum creatinine time series that calculates the risk function for ninety-day mortality. We performed a 70/30 cross validation analysis to assess the accuracy of the model. All creatinine time series exhibited nonlinear risk function in relation to ninety-day mortality and their addition to other clinical factors improved the model discrimination. For any given severity of AKI, patients with complete renal recovery, as manifested by the return of the discharge creatinine to the baseline value, experienced a significant decrease in the odds of dying within ninety days of admission compared to patients with partial recovery. Yet, for any severity of AKI even complete renal recovery did not entirely mitigate the increased odds of dying as patients with mild AKI and complete renal recovery still had significantly increased odds for dying compared to patients without AKI (odds ratio 1,48 (95% confidence interval 1.30-1.68). We demonstrate the nonlinear relationship between both severity and recovery of renal dysfunction and ninety-day mortality after major surgery. We have developed an easily applicable computer algorithm that calculates this complex relationship.