Effect of mean arterial pressure, haemoglobin and blood transfusion during cardiopulmonary bypass on post-operative acute kidney injury
Effect of mean arterial pressure, haemoglobin and blood transfusion during cardiopulmonary bypass on post-operative acute kidney injury
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DOI：
10.1093/ndt/gfr275
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发表时间：
2012-01-01
影响因子：
6.1
通讯作者：
Haase-Fielitz, Anja
中科院分区：
文献类型：
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作者：
Haase, Michael;Bellomo, Rinaldo;Haase-Fielitz, Anja
背景心脏手术后的急性肾损伤（阿基）是一种常见且严重的疾病，需要花费大量费用。在心肺转流（CPB）手术期间，可变因素可能导致术后阿基。它们的回避可能是肾保护的潜在目标。本研究的目的是使用混合logistic多变量模型，通过步枪（肾脏风险、损伤、衰竭、肾功能丧失和终末期肾病）分类和其他阈值，确定术中低血压、贫血或其组合、红细胞输注或血管加压剂使用是否是术后阿基的独立风险因素。我们分析了920例连续体外循环心脏手术患者的381468次平均动脉压（MAP）测量结果。总体而言，19.5%的患者发生阿基，住院死亡率增加8.2倍。血红蛋白浓度是阿基的独立风险因素{比值比[OR] 1.16/g/dL降低[95%置信区间（CI）1.05-1.31]; P - 0.018}，全身动脉血氧饱和度和压力值未进一步加强这种关联。MAP单独或血管加压剂给药与阿基无关，但红细胞输注量与AKI相关，其影响在血红蛋白水平>8 g/dL（>5 mmol/L）时明显。在重度贫血患者（MAP曲线下面积的第75百分位数）中，8 g/dL（>5 mmol/L）可能有助于减少接受心脏手术的患者的阿基，并代表未来受控干预的目标。
Background. Acute kidney injury (AKI) after cardiac surgery is a common and serious condition carrying significant costs. During cardiopulmonary bypass (CPB) surgery, modifiable factors may contribute to post-operative AKI. Their avoidance might be a potential target for nephroprotection.Methods. The objective of the present study was to identify and determine whether intraoperative hypotension, anaemia, or their combination, red blood cell transfusion or vasopressor use are independent risk factors for postoperative AKI defined by the RIFLE (renal Risk, Injury, Failure, Loss of renal function and End-stage renal disease) classification and other thresholds using a mixed logistic multivariate model.Results. We analysed 381 468 mean arterial pressure (MAP) measurements from 920 consecutive on-pump cardiac surgery patients. Overall, 19.5% developed AKI which was associated with an 8.2-fold increase in-hospital mortality. Haemoglobin concentration was an independent risk factor for AKI {odds ratio [OR] 1.16 per g/dL decrease [95% confidence interval (CI) 1.05-1.31]; P - 0.018} with systemic arterial oxygen saturation and pressure values not adding further strength to such an association. MAP alone or vasopressor administration was not independently associated with AKI but volume of red blood cell transfusion was, with its effect being apparent at a haemoglobin level of >8 g/dL (>5 mmol/L). In patients with severe anaemia (75th percentile of area under the curve MAP 8 g/dL (>5 mmol/L) may help decrease AKI in patients undergoing cardiac surgery and represent targets for future controlled interventions.