Incidence and predictors of acute kidney injury after transcatheter aortic valve replacement
Incidence and predictors of acute kidney injury after transcatheter aortic valve replacement
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DOI：
10.1016/j.ahj.2012.01.009
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发表时间：
2012-06-01
影响因子：
4.8
通讯作者：
Waksman, Ron
中科院分区：
文献类型：
--
作者：
Barbash, Israel M.;Ben-Dor, Itsik;Waksman, Ron
背景：接受经导管主动脉瓣置换术（TAVR）的患者发生急性肾损伤（AKI）的风险增加。瓣膜学术研究联盟（VARC）最近公布了TAVR后AKI的标准。我们的目的是确定预测因素，评估TAVR后AKI的预后影响，并比较AKI的各种标准。方法回顾性分析行TAVR的主动脉瓣狭窄患者的围术期AKI （= 0.3 mg/dL或>= 1.5倍基线）或修改后的风险、损伤、衰竭、损失和终末期肾病（RIFLE）标准（估计48小时肾小球滤过率>降低25%）。结果165例TAVR患者中有24例（14.6%）发生急性肾损伤，符合VARC定义。根据RIFLE标准，19例患者发生急性肾损伤（11.5%）。男性（63% vs 38%, P = 0.03）和接受输血的患者（63% vs 39%, P = 0.04）更容易发生AKI。在多变量分析中，只有输血是AKI的预测因子（优势比3.74,95% CI 1.36-10.3）。与没有AKI的患者相比，发生AKI的患者有更高的住院率（21%对4%，P = 0.007）和30天死亡率（29%对7%，P = 0.004）。结论急性肾损伤是TAVR的常见并发症。tavr后基线肌酐即使小幅升高（0.3 mg/dL）也与较差的预后相关。这些患者预后不良，应鼓励改进患者选择和仔细管理，以预防这种并发症。（美国心脏杂志2012；163:1031-6）
Background Patients undergoing transcatheter aortic valve replacement (TAVR) are at increased risk for acute kidney injury (AKI). The Valve Academic Research Consortium (VARC) recently published criteria for AKI after TAVR. We aimed to identify predictors, assess the prognostic impact of AKI after TAVR, and compare various criteria for AKI.Methods Patients with aortic stenosis undergoing TAVR were retrospectively analyzed for periprocedural AKI (= 0.3 mg/dL or >= 1.5x baseline) or according to the modified Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria (decrease of >25% in estimated glomerular filtration rate at 48 hours).Results Acute kidney injury, according to the VARC definition, occurred in 24 (14.6%) of 165 patients after TAVR. Acute kidney injury, according to RIFLE criteria, occurred in 19 patients (11.5%). Men (63% vs 38%, P = .03) and patients receiving blood transfusion (63% vs 39%, P = .04) were more likely to develop AKI. In multivariable analysis, only blood transfusion emerged as a predictor for AKI (odds ratio 3.74, 95% CI 1.36-10.3). Patients who developed AKI had higher in-hospital (21% vs 4%, P = .007) and 30-day mortality (29% vs 7%, P = .004) as compared with patients without AKI.Conclusion Acute kidney injury is a frequent complication of TAVR. Even a small increase (0.3 mg/dL) in baseline creatinine post-TAVR is associated with worse outcome. The poor prognosis of these patients should encourage improvement in patient selection and careful management for prevention of this complication. (Am Heart J 2012;163:1031-6.)