Impact of renal dysfunction on outcomes of coronary artery bypass surgery - Results from the Society of Thoracic Surgeons National Adult Cardiac Database
Impact of renal dysfunction on outcomes of coronary artery bypass surgery - Results from the Society of Thoracic Surgeons National Adult Cardiac Database
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DOI：
10.1161/circulationaha.105.580084
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发表时间：
2006-02-28
期刊：
影响因子：
37.8
通讯作者：
Peterson, ED
中科院分区：
文献类型：
--
作者：
Cooper, WA;O'Brien, SM;Peterson, ED
背景--尽管已知终末期肾病患者在冠状动脉旁路移植术（CABG）后死亡率高，但轻度肾损害的影响尚未得到充分研究。本研究的目的是比较结果在接受CABG患者的范围从肾功能正常的依赖dialys.Methods和结果-我们回顾了483 914例患者接受隔离CABG从2000年7月至2003年12月，使用胸外科医师协会国家成人心脏数据库。估计了使用肾病饮食改良研究配方的患者的肾小球滤过率（GFR）。在校正了其他27个已知的临床危险因素后，采用多变量logistic回归分析确定GFR与手术死亡率和发病率（卒中、再次手术、深部胸骨感染、通气> 48小时、术后住院时间> 2周）的相关性。术前肾功能不全（RD）在CABG患者中很常见，51%有轻度RD（GFR 60 - 90 mL/min/1.73 m2，不包括透析），24%中度RD（GFR 30 - 59 mL/min/1.73 m2，不包括透析），2%重度RD（GFR < 30 mL/ min/1.73 m2，不包括透析），1.5%需要透析。手术死亡率与肾功能下降呈负相关，从肾功能正常的患者的1.3%上升到未接受透析的重度RD患者的9.3%和透析依赖患者的9.0%。调整其他协变量后，术前GFR是手术死亡率和morbiditys.Conclusions最强大的预测因子之一，术前RD是常见的CABG人群，并进行重要的预后意义。术前肾功能评估应纳入临床风险评估和预测模型。
Background - Although patients with end-stage renal disease are known to be at high risk for mortality after coronary artery bypass graft (CABG) surgery, the impact of lesser degrees of renal impairment has not been well studied. The purpose of this study was to compare outcomes in patients undergoing CABG with a range from normal renal function to dependence on dialysis.Methods and Results - We reviewed 483 914 patients receiving isolated CABG from July 2000 to December 2003, using the Society of Thoracic Surgeons National Adult Cardiac Database. Glomerular filtration rate (GFR) was estimated for patients with the use of the Modification of Diet in Renal Disease study formula. Multivariable logistic regression was used to determine the association of GFR with operative mortality and morbidities ( stroke, reoperation, deep sternal infection, ventilation > 48 hours, postoperative stay > 2 weeks) after adjustment for 27 other known clinical risk factors. Preoperative renal dysfunction (RD) was common among CABG patients, with 51% having mild RD ( GFR 60 to 90 mL/min per 1.73 m(2), excludes dialysis), 24% moderate RD ( GFR 30 to 59 mL/min per 1.73 m(2), excludes dialysis), 2% severe RD (GFR < 30 mL/ min per 1.73 m(2), excludes dialysis), and 1.5% requiring dialysis. Operative mortality rose inversely with declining renal function, from 1.3% for those with normal renal function to 9.3% for patients with severe RD not on dialysis and 9.0% for those who were dialysis dependent. After adjustment for other covariates, preoperative GFR was one of the most powerful predictors of operative mortality and morbidities.Conclusions - Preoperative RD is common in the CABG population and carries important prognostic importance. Assessment of preoperative renal function should be incorporated into clinical risk assessment and prediction models.