Predicting kidney disease progression in patients with acute kidney injury after cardiac surgery
Predicting kidney disease progression in patients with acute kidney injury after cardiac surgery
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DOI：
10.1016/j.jtcvs.2018.01.093
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发表时间：
2018-06-01
影响因子：
6
通讯作者：
Frendl, Gyorgy
中科院分区：
文献类型：
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作者：
Mizuguchi, K. Annette;Huang, Chuan-Chin;Frendl, Gyorgy
目的：该研究的目的是确定可能发生进行性肾功能不全的患者在心脏手术后出院前，患者可以在急性肾脏疾病（急性肾脏疾病）患者中进行定期血清肌酐测量，从而有针对性地监测该高危人群的肾功能。进展为急性肾脏疾病的风险（介于急性肾损伤和慢性肾脏疾病之间的状态）从经历心脏手术的患者中的急性肾损伤阶段（肾脏疾病：改善总体结果）建模。一个修改后的泊松回归与强大的误差方差被用来评估急性肾损伤阶段和急性肾脏疾病（定义为手术后2-4周肌酐加倍）的发展之间的关联在这个观察study.Results：急性肾脏疾病发生在4.4%的患者没有预先存在的肾脏疾病和4.8%的患者预先存在的慢性肾脏疾病。急性肾损伤以分级方式预测急性肾脏疾病的发生，其中急性肾损伤的分期越高，进行性肾脏疾病的相对风险越高（受试者工作特征曲线下面积= 0.82）。无论基线肾功能如何，这种相关性都持续存在（P
Objective: The study objective was to identify patients who are likely to develop progressive kidney dysfunction (acute kidney disease) before their hospital discharge after cardiac surgery, allowing targeted monitoring of kidney function in this at-risk group with periodic serum creatinine measurements.Methods: Risks of progression to acute kidney disease (a state in between acute kidney injury and chronic kidney disease) were modeled from acute kidney injury stages (Kidney Disease: Improving Global Outcomes) in patients undergoing cardiac surgery. A modified Poisson regression with robust error variance was used to evaluate the association between acute kidney injury stages and the development of acute kidney disease (defined as doubling of creatinine 2-4 weeks after surgery) in this observational study.Results: Acute kidney disease occurred in 4.4% of patients with no preexisting kidney disease and 4.8% of patients with preexisting chronic kidney disease. Acute kidney injury predicted development of acute kidney disease in a graded manner in which higher stages of acute kidney injury predicted higher relative risk of progressive kidney disease (area under the receiver operator characteristic curve = 0.82). This correlation persisted regardless of baseline kidney function (P