Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival
Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival
复制标题
DOI：
10.1681/asn.2003100875
复制
发表时间：
2005-01-01
影响因子：
13.6
通讯作者：
Stegeman, CA
中科院分区：
文献类型：
--
作者：
Loef, BG;Epema, AH;Stegeman, CA
术后肾功能恶化是体外循环心脏手术后的严重并发症，并与住院死亡率增加有关。然而，术后肾脏恶化患者的远期预后尚不完全确定。因此，对术后肾功能恶化患者的住院死亡率和长期存活率进行了研究。研究对象为1991年在体外循环下接受心脏手术的843名患者。145例(17.2%)患者术后肾功能恶化(术后第一周血肌酐升高至少25%)。在这些患者中，住院死亡率为14.5%，而无肾功能恶化的患者为1.1%(P<；0.001)。多因素分析显示，住院死亡率与术后肾功能恶化、再探查、术后脑卒中、手术时间、年龄和糖尿病显著相关。在活着出院的患者中，在长期随访期间(100mo)，肾功能恶化的患者(n=124)的死亡率显著高于无肾功能恶化的患者(危险比1.83；95%可信区间1.38~3.20)。此外，在调整了其他独立相关因素后，术后肾功能恶化患者的死亡风险仍然较高(风险比1.63；95%可信区间1.15至2.32)。长期死亡率升高的风险与出院时肾功能是否恢复无关。结论：心脏手术患者术后肾功能恶化不仅会导致住院死亡率的增加，而且还会对长期生存产生不利影响。
Postoperative renal function deterioration is a serious complication after cardiac surgery with cardiopulmonary bypass and is associated with increased in-hospital mortality. However, the long-term prognosis of patients with postoperative renal deterioration is not fully determined yet. Therefore, both in-hospital mortality and long-term survival were studied in patients with postoperative renal function deterioration. Included were 843 patients who underwent cardiac surgery with cardiopulmonary bypass in 1991. Postoperative renal function deterioration (increase in serum creatinine in the first postoperative week of at least 25%) occurred in 145 (17.2%) patients. In these patients, in-hospital mortality was 14.5%, versus 1.1% in patients without renal function deterioration (P < 0.001). Multivariate analysis significantly associated in-hospital mortality with postoperative renal function deterioration, re-exploration, postoperative cerebral stroke, duration of operation, age, and diabetes. In patients who were discharged alive, during long-term follow-up (100 mo), mortality was significantly increased in the patients with renal function deterioration (n = 124) as compared with those without renal function deterioration (hazard ratio 1.83; 95% confidence interval 1.38 to 3.20). Also after adjustment for other independently associated factors, the risk for mortality in patients with postoperative renal function deterioration remained elevated (hazard ratio 1.63; 95% confidence interval 1.15 to 2.32). The elevated risk for long-term mortality was independent of whether renal function had recovered at discharge from hospital. It is concluded that postoperative renal function deterioration in cardiac surgical patients not only results in increased in-hospital mortality but also adversely affects long-term survival.