Impact of perioperative acute kidney injury as a severity index for thirty-day readmission after cardiac surgery.
Impact of perioperative acute kidney injury as a severity index for thirty-day readmission after cardiac surgery.
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围手术期急性肾脏损伤是心脏手术后三十天再入院的严重程度指数的影响。
DOI：
10.1016/j.athoracsur.2013.07.090
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发表时间：
2014-01
影响因子：
4.6
通讯作者：
Malenka, David J.
中科院分区：
文献类型：
--
作者：
Brown, Jeremiah R.;Parikh, Chirag R.;Ross, Cathy S.;Kramer, Robert S.;Magnus, Patrick C.;Chaisson, Kristine;Boss, Richard A., Jr.;Helm, Robert E.;Horton, Susan R.;Hofmaster, Patricia;Desaulniers, Helen;Blajda, Pamela;Westbrook, Benjamin M.;Duquette, Dennis;LeBlond, Kelly;Quinn, Reed D.;Jones, Cheryl;DiScipio, Anthony W.;Malenka, David J.
在美国接受心脏手术的患者中，15-20%在30天内再次住院。目前预测再入院的模型尚未评估术后急性肾损伤（阿基）严重程度与30天再入院之间的相关性。我们收集了2008年7月至2010年12月期间在北方新英格兰心血管疾病研究组心脏手术登记处（NNE）的七家成员医院接受冠状动脉旁路移植术（CABG）或瓣膜手术的2,209例连续患者的数据。检索每家医院的管理数据，以确定出院后30天内再次入住索引医院的所有患者。我们根据阿基网络定义将阿基分期定义为增加0.3或50%（第1阶段）、增加2倍（第2阶段）和增加3倍或0.5倍（如果基线血清肌酐至少为4.0（mg/dL）或新透析（第3阶段））。我们使用多变量logistic回归评估阿基分期与30天再入院之间的相关性。有260例患者在30天内再次入院（12.1%）。中位再入院时间为9（IQR 4-16）天。心脏手术后未发生阿基的患者30天再入院率为9.3%，而发生阿基1期（16.1%）、阿基2期（21.8%）和阿基3期（28.6%，p <0.001）的患者30天再入院率为9.3%。阿基1期（1.81; 1.35，2.44）、2期（2.39; 1.38，4.14）和3期（3.47; 1.85-6.50）的校正比值比。通过增加阿基分期（c-统计量0.65，p = 0.001）和14.6%的净重新分类率（95%CI：5.05%至24.14%，p = 0.003），预测再入院的模型得到显著改善。除了更传统的患者特征外，在评估患者再入院风险时，还应使用术后阿基的严重程度。
Of patients undergoing cardiac surgery in the United States, 15–20% are re-hospitalized within 30-days. Current models to predict readmission have not evaluated the association between severity of post-operative acute kidney injury (AKI) and 30-day readmissions. We collected data from 2,209 consecutive patients who underwent either coronary artery bypass (CABG) or valve surgery at seven member hospitals of the Northern New England Cardiovascular Disease Study Group Cardiac Surgery Registry (NNE) between July 2008 and December 2010. Administrative data at each hospital was searched to identify all patients readmitted to the index hospital within 30 days of discharge. We defined AKI Stages by the AKI Network definition of 0.3 or 50% increase (Stage 1), 2-fold increase (stage 2) and a 3-fold or 0.5 increase if the baseline serum creatinine was at least 4.0 (mg/dL) or new dialysis (stage 3). We evaluate the association between stages of AKI and 30-day readmission using multivariate logistic regression. There were 260 patients readmitted within 30-days (12.1%). The median time to readmission was 9 (IQR 4–16) days. Patients not developing AKI following cardiac surgery had a 30-day readmission rate of 9.3% compared to patients developing AKI stage 1 (16.1%), AKI stage 2 (21.8%) and AKI stage 3 (28.6%, p <0.001). Adjusted odds ratios for AKI stage 1 (1.81; 1.35, 2.44), stage 2 (2.39; 1.38, 4.14) and stage 3 (3.47; 1.85–6.50). Models to predict readmission were significantly improved with the addition of AKI stage (c-statistic 0.65, p = 0.001) and net reclassification rate of 14.6% (95%CI: 5.05% to 24.14%, p = .003). In addition to more traditional patient characteristics, the severity of post-operative AKI should be used when assessing a patient’s risk for readmission.
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影响因子：
4.6
作者：
Brown, Jeremiah R.;Cochran, Richard P.;O'Connor, Gerald T.
通讯作者：
O'Connor, Gerald T.
影响因子：
39
作者：
Donze, Jacques;Aujesky, Drahomir;Schnipper, Jeffrey L.
通讯作者：
Schnipper, Jeffrey L.
影响因子：
158.5
作者：
Jencks, Stephen F.;Williams, Mark V.;Coleman, Eric A.
通讯作者：
Coleman, Eric A.
影响因子：
1.9
作者：
DELONG, ER;DELONG, DM;CLARKEPEARSON, DI
通讯作者：
CLARKEPEARSON, DI
DOI：
10.1186/cc5713
发表时间：
2007
期刊：
Critical care (London, England)
影响因子：
--
作者：
Mehta RL;Kellum JA;Shah SV;Molitoris BA;Ronco C;Warnock DG;Levin A;Acute Kidney Injury Network
通讯作者：
Acute Kidney Injury Network