Outcome in a post-cardiac surgery population with acute renal failure requiring dialysis: does age make a difference?
Outcome in a post-cardiac surgery population with acute renal failure requiring dialysis: does age make a difference?
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DOI：
10.1093/ndt/gfg043
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发表时间：
2003-04-01
影响因子：
6.1
通讯作者：
Lameire, N
中科院分区：
文献类型：
--
作者：
Van Den Noortgate, N;Mouton, V;Lameire, N
背景。接受心脏手术的患者中有 1-5% 会出现需要透析 (ARF-d) 的急性肾衰竭 (ARF)，并且与较高的院内死亡率相关。年龄是发生 ARF 的已知危险因素之一。随着人口老龄化的加剧，肾脏科医生将面临大量心脏手术后需要透析的老年患者。我们研究的目的是评估年龄对院内死亡率的影响及其危险因素。方法。 1997 年 1 月至 2001 年 10 月期间，有 82 名心脏手术后发生 ARF 并需要透析的患者被纳入研究。研究了两组患者：年轻人群（< 70 岁，42 名患者，平均年龄 59 +/- 10）和老年人群（大于或等于 70 岁，40 名患者，平均年龄 76 +/- 4）。使用 SAPS（简化急性生理学评分）、Liano 评分和 SHARF（Stuivenberg 医院急性肾衰竭）评分来评估疾病的严重程度。结果。 ARF-d 人群的总体死亡率为 56.1%。年轻患者组（61.9%）和老年患者组（50.0%）的死亡率没有差异。除体重（P = 0.02）和术前肾小球滤过率（P = 0.0001）外，两组的基线和手术特征非常相似。老年人和年轻人之间的评分系统没有发现显着差异（SAPS P = 0.52；Liano P = 0.96；SHARF TO P = 0.06；SHARF T48 P = 0.15）。老年人的死亡率与开始肾脏替代治疗（RRT）（P = 0.002）之前的低血压、机械通气（P = 0.002）、多器官衰竭（MOF）（P = 0.0001）以及严重程度模型中较高的评分（SAPS：P = 0.01；Liano：P < 0.0001 和 SHARF：P < 0.0001）显着相关。结论。因 ARF 心脏手术后需要透析的老年人的结果与年轻人的结果相当。老年人和年轻人之间的疾病严重程度没有显着差异。预测老年人死亡率的变量是开始 RRT 前 24 小时是否存在 MOF、机械通气和低血压。这些发现表明，当肾病专家因心脏手术后因 ARF 需要透析的老年患者被请时，年龄本身并不是拒绝 RRT 的理由。
Background. Acute renal failure (ARF), requiring dialysis (ARF-d), develops in 1-5% of patients undergoing cardiac surgery and is associated with higher in-hospital mortality. Age is one of the known risk factors for the development of ARF. As the ageing population is increasing, the nephrologist will be faced with a large population of elderly patients requiring dialysis following cardiac surgery. The aim of our study was to evaluate the influence of age on and the risk factors for in-hospital mortality.Methods. Eighty-two patients with ARF following cardiac surgery and requiring dialysis between January 1997 and October 2001 were included. Two groups of patients were studied: the younger population (< 70 years, 42 patients, mean age 59 +/- 10) and an elderly population (greater than or equal to 70 years, 40 patients, mean age 76 +/- 4). Severity of disease was evaluated using the SAPS (Simplified Acute Physiology Score), the Liano score and the SHARF (Stuivenberg Hospital Acute Renal Failure) score.Results. Overall mortality in the population with ARF-d was 56.1%. No difference in mortality rate was found between the younger (61.9%) and elderly patient group (50.0%). The two groups were very similar in baseline and procedural characteristics with exception of body weight (P = 0.02) and preoperative glomerular filtration rate (P = 0.0001). No significant difference was found in the scoring systems between the old and the young (SAPS P = 0.52; Liano P = 0.96; SHARF TO P = 0.06; SHARF T48 P = 0.15). Mortality in the elderly was significantly correlated with hypotension before starting renal replacement therapy (RRT) (P = 0.002), mechanical ventilation (P = 0.002), presence of multiorgan failure (MOF) (P = 0.0001) and higher scores in the severity models (SAPS: P = 0.01; Liano: P < 0.0001 and SHARF: P < 0.0001).Conclusion. The outcome in the elderly requiring dialysis due to ARF post-cardiac surgery is comparable with the outcome in a younger population. No significant difference was found in severity of disease between the elderly and the younger. Variables predicting mortality in the elderly are the presence of MOF, mechanical ventilation and hypotension 24 h before starting RRT. These findings indicate that at the time the nephrologist is called for an elderly patient requiring dialysis due to ARF following cardiac surgery, age per se is not a reason to withhold RRT.