Haptoglobin Administration in Cardiovascular Surgery Patients: Its Association With the Risk of Postoperative Acute Kidney Injury
Haptoglobin Administration in Cardiovascular Surgery Patients: Its Association With the Risk of Postoperative Acute Kidney Injury
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DOI：
10.1213/ane.0000000000002093
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发表时间：
2017-06-01
影响因子：
5.7
通讯作者：
Mizobuchi, Satoshi
中科院分区：
文献类型：
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作者：
Kubota, Kenta;Egi, Moritoki;Mizobuchi, Satoshi
背景：急性肾损伤（AKI）经常发生在心脏手术后。在心脏手术期间，血浆游离血红蛋白（fHb）会因溶血而增加。由于血浆 fHb 被认为具有肾毒性，因此作为 fHb 清除剂的触珠蛋白可能具有预防术后 AKI (pAKI) 的潜力。然而，很少有研究评估术中使用触珠蛋白与心脏术后 AKI 发生率之间的关系。 方法：本研究是一项回顾性观察研究，旨在评估术中使用触珠蛋白与心脏手术患者 AKI 发生率之间的独立关联。我们筛选了2008年至2015年需要体外循环的心脏手术患者。我们排除了术前需要肾脏替代治疗的患者。我们还排除了接受降主动脉置换术的患者。 pAKI 根据 AKI 网络标准定义。使用倾向评分匹配模型来调整混杂因素。为了进行敏感性分析，我们进一步开发了逻辑回归模型。结果：本研究纳入了 1326 名患者。整个队列中 AKI 的发生率为 25.5%（338 名患者）。 260 名患者 (19.6%) 接受了触珠蛋白治疗。在粗队列中，施用触珠蛋白的患者 AKI 发生率为 24.6%，与未施用触珠蛋白的患者 25.7% 的发生率没有显着差异（P =.72；比值比，0.94 [95% 置信区间，0.69-1.29]）。经过倾向评分匹配后，每组有 249 名患者（总共 498 名患者）。在这个倾向评分匹配队列中，给予触珠蛋白的患者 AKI 发生率为 22.5%，显着低于未给予触珠蛋白的患者 30.9% 的发生率 (P =.033；比值比，0.65 [0.43-0.97])。在我们的 pAKI 风险逻辑回归模型中，触珠蛋白给药与 AKI 风险降低独立相关（P = .029；调整后优势比，0.54 [0.31, 0.93]）。结论：在这项假设生成的单中心回顾性观察研究中，术中给予触珠蛋白与心血管手术后 AKI 风险降低独立相关。
BACKGROUND: Acute kidney injury (AKI) often occurs after cardiac surgery. During cardiac surgery, plasma free hemoglobin (fHb) would increase due to hemolysis. Since plasma fHb is thought to be nephrotoxic, haptoglobin, which is an fHb scavenger, may have the potential to prevent postoperative AKI (pAKI). However, there have been few studies in which the association of intraoperative administration of haptoglobin with the incidence of AKI after cardiac surgery was assessed.METHODS: This study was a retrospective observational study to assess the independent association of intraoperative administration of haptoglobin with the incidence pAKI in cardiac surgery patients. We screened cardiac surgery patients who required cardiopulmonary bypass from 2008 to 2015. We excluded patients who required renal replacement therapy preoperatively. We also excluded patients in whom descending aortic replacement was performed. pAKI was defined according to AKI Network criteria. A propensity score-matched model was used to adjust confounders. For sensitive analysis, we further developed a logistic regression model.RESULTS: We included 1326 patients in this study. The incidence of AKI in the total cohort was 25.5% (338 patients). Haptoglobin was administered in 260 patients (19.6%). In the crude cohort, the incidence of AKI in patients with haptoglobin administration was 24.6%, which was not significantly different from the incidence of 25.7% in those without haptoglobin administration (P =.72; odds ratio, 0.94 [95% confidence interval, 0.69-1.29]). After propensity score matching, we had 249 patients in each group (for a total of 498 patients). In this propensity score-matched cohort, the incidence of AKI in patients with haptoglobin administration was 22.5%, which was significantly lower than the incidence of 30.9% in those without haptoglobin administration (P =.033; odds ratio, 0.65 [0.43-0.97]). In our logistic regression model for the risk of pAKI, haptoglobin administration was independently associated with decreased risk of AKI (P =.029; adjusted odds ratio, 0.54 [0.31, 0.93]).CONCLUSIONS: In this hypothesis-generating, single-center retrospective observational study, intraoperative administration of haptoglobin was independently associated with lower risk of AKI after cardiovascular surgery.