Duration of acute kidney injury impacts long-term survival after cardiac surgery.
Duration of acute kidney injury impacts long-term survival after cardiac surgery.
复制标题
DOI：
10.1016/j.athoracsur.2010.04.039
复制
发表时间：
2010-10
影响因子：
4.6
通讯作者：
Parikh, Chirag R.
中科院分区：
文献类型：
--
作者：
Brown, Jeremiah R.;Kramer, Robert S.;Coca, Steven G.;Parikh, Chirag R.
心脏手术后的急性肾损伤（阿基）与更差的结局相关。然而，目前尚不清楚不良长期后果如何根据阿基的持续时间而变化。我们试图确定阿基持续时间与生存率之间的关系。从2002年到2007年，在北方新英格兰的一个医疗中心收集了4,987名心脏手术患者的血清肌酐（SCr）。阿基定义为SCr较基线增加≥0.3（mg/dL）或≥50%，并进一步分类为阿基网络分期。阿基持续时间定义为阿基存在的天数，并分类为：无阿基、阿基持续1-2天、3-6天和≥7天。39%的患者发生阿基。阿基持续时间的长期生存率显著不同（p < 0.001）。阿基持续时间、校正风险比（HR）和死亡率（无阿基作为参考）的95%置信区间的患者比例为：1-2天（18%，HR 1.66; 1.32-2.09）、3-6天（11%，HR 1.94; 1.51-2.49）、≥7天（9%，HR 3.40; 2.73-4.25）。当从分析中排除住院期间死亡的患者时，阿基持续时间与长期死亡率的分级关系仍然存在（p < 0.001）。倾向匹配分析证实了结果。心脏手术后阿基的持续时间与长期死亡率成正比。阿基对长期死亡率的剂量依赖性作用有助于缩小关联和因果关系之间的差距，因此阿基分期和阿基持续时间对患者护理具有重要意义，并可帮助临床医生评估院内和出院后死亡的风险。
Acute kidney injury (AKI) following cardiac surgery is associated with worse outcomes. However, it is not known how adverse long-term consequences vary according to the duration of AKI. We sought to determine the association between duration of AKI and survival. 4,987 cardiac surgery patients from 2002 through 2007 with serum creatinine (SCr) collection at a medical center in northern New England. AKI was defined as a ≥0.3 (mg/dL) or ≥50% increase in SCr from baseline and further classified into AKI network stages. Duration of AKI was defined by the number of days AKI was present and categorized by: no AKI, AKI for 1–2, 3–6 and ≥7 days. 39% of patients developed AKI. Long-term survival was significantly different by AKI duration (p < 0.001). The proportion of patients with AKI duration, adjusted hazard ratios (HR) and 95% confidence intervals for mortality (no AKI as referent), were: 1–2 days (18%, HR 1.66; 1.32–2.09), 3–6 days (11%, HR 1.94; 1.51–2.49), ≥7 days (9%, HR 3.40; 2.73–4.25). This graded relationship of duration of AKI with long-term mortality persisted when patients who died during hospitalization were excluded from analysis (p < 0.001). Propensity matched analysis confirmed results. The duration of AKI after cardiac surgery is directly proportional to long-term mortality. This AKI dose-dependent effect on long-term mortality helps to close the gap between association and causation, whereby AKI stages and AKI duration have important implications for patient care and can aid clinicians in evaluating the risk of in-hospital and post discharge death.
登录
查看更多内容
影响因子：
4.6
作者：
Brown, Jeremiah R.;Kramer, Robert S.;Coca, Steven G.;Parikh, Chirag R.
通讯作者：
Parikh, Chirag R.
DOI：
10.2215/cjn.00820209
发表时间：
2009-11-01
影响因子：
9.8
作者：
Pickering, John W.;Frampton, Christopher M.;Endre, Zoltan H.
通讯作者：
Endre, Zoltan H.
DOI：
10.1186/cc6997
发表时间：
2008
期刊：
Critical care (London, England)
影响因子：
--
作者：
Lopes JA;Fernandes P;Jorge S;Gonçalves S;Alvarez A;Costa e Silva Z;França C;Prata MM
通讯作者：
Prata MM
影响因子：
4.6
作者：
Brown, Jeremiah R.;Cochran, Richard P.;O'Connor, Gerald T.
通讯作者：
O'Connor, Gerald T.
影响因子：
19.6
作者：
Liano, F.;Felipe, C.;Severiano, S.
通讯作者：
Severiano, S.