Acute kidney injury in septua- and octogenarians after cardiac surgery.
Acute kidney injury in septua- and octogenarians after cardiac surgery.
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DOI：
10.1186/1471-2261-11-52
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发表时间：
2011-08-11
影响因子：
2.1
通讯作者：
Diez C
中科院分区：
文献类型：
--
作者：
Ried M;Puehler T;Haneya A;Schmid C;Diez C
越来越多的老年人和老年人接受心脏手术。急性肾损伤（阿基）是外科手术后常见的并发症。我们研究了阿基的发生率及其对30天死亡率的影响。一项2006年1月至2009年8月的回顾性研究，纳入了299名老年人，这些老年人在性别和外科手术方面与一所大学医院的299名七十岁老人相匹配。主要终点是步枪定义（风险、损伤、衰竭、损失、终末期肾病）提出的术后阿基。次要终点为30天死亡率。围手术期死亡率采用欧洲心脏手术风险评估系统（EuroSCORE）进行预测。与70岁以上的老年人相比，老年人的平均logistic EuroSCORE显著更高（13.2% vs 8.5%; p < 0.001），估计肾小球滤过率（eGFR）< 60 ml × min-1 × 1.73 m-2的患者比例更高。相比之下，70岁以上的老年人显示出略高的中位体重指数（28 kg × m-2 vs 26 kg × m-2），手术时更频繁地吸烟（6.4% vs 1.6%，p < 0.001）。21.7%的七十岁老人和21.4%的六十岁老人发生急性肾损伤和衰竭，而超过30%的患者有阿基的风险（分别为30%和36.3%）。在两个年龄组中，阿基程度越高，死亡、肾脏替代治疗和重症监护室和医院住院时间延长的风险逐步增加，但两者之间没有差异。总体30天死亡率为6%的七十岁和7.7%的六十岁（p = 0.52）。步枪分类为30天死亡率提供了准确的风险评估和公平的区分能力。步枪标准允许识别心脏手术后的阿基患者。心脏手术后败血症和老年人阿基的高发病率应促使使用步枪标准来识别风险患者，并应刺激针对阿基的机构措施，作为高龄患者的质量改进计划。
An increasing number of septua- and octogenarians undergo cardiac surgery. Acute kidney injury (AKI) still is a frequent complication after surgery. We examined the incidence of AKI and its impact on 30-day mortality. A retrospective study between 01/2006 and 08/2009 with 299 octogenarians, who were matched for gender and surgical procedure to 299 septuagenarians at a university hospital. Primary endpoint was AKI after surgery as proposed by the RIFLE definition (Risk, Injury, Failure, Loss, End-stage kidney disease). Secondary endpoint was 30-day mortality. Perioperative mortality was predicted with the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE). Octogenarians significantly had a mean higher logistic EuroSCORE compared to septuagenarians (13.2% versus 8.5%; p < 0.001) and a higher proportion of patients with an estimated glomerular filtration rate (eGFR) < 60 ml × min-1 × 1.73 m-2. In contrast, septuagenarians showed a slightly higher median body mass index (28 kg × m-2 versus 26 kg × m-2) and were more frequently active smoker at time of surgery (6.4% versus 1.6%, p < 0.001). Acute kidney injury and failure developed in 21.7% of septuagenarians and in 21.4% of octogenarians, whereas more than 30% of patients were at risk for AKI (30% and 36.3%, respectively). Greater degrees of AKI were associated with a stepwise increase in risk for death, renal replacement therapy and prolonged stays at the intensive care unit and at the hospital in both age groups, but without differences between them. Overall 30-day mortality was 6% in septuagenarians and 7.7% in octogenarians (p = 0.52). The RIFLE classification provided accurate risk assessment for 30-day mortality and fair discriminatory power. The RIFLE criteria allow identifying patients with AKI after cardiac surgery. The high incidence of AKI in septua- and octogenarians after cardiac surgery should prompt the use of RIFLE criteria to identify patients at risk and should stimulate institutional measures that target AKI as a quality improvement initiative for patients at advanced age.
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影响因子：
3.3
作者：
Abdel-Kader K;Palevsky PM
通讯作者：
Palevsky PM
影响因子：
6.1
作者：
Van Den Noortgate, N;Mouton, V;Lameire, N
通讯作者：
Lameire, N
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Adams, David H
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