Congenital heart surgery in infants: Effects of acute kidney injury on outcomes
Congenital heart surgery in infants: Effects of acute kidney injury on outcomes
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DOI：
10.1016/j.jtcvs.2011.06.021
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发表时间：
2012-02-01
影响因子：
6
通讯作者：
Jefferies, John L.
中科院分区：
文献类型：
--
作者：
Blinder, Joshua J.;Goldstein, Stuart L.;Jefferies, John L.
目的：我们试图描述与接受心脏手术的婴儿术后急性肾损伤相关的因素和结局。方法：我们回顾性研究了430例因先天性缺陷接受心脏手术的婴儿（< 90天）。采用儿科急性肾损伤网络分类的修订版本，我们进行了统计分析，以检测与术后急性肾损伤相关的因素和结局。结果：225例患者（52%）发生了术后急性肾损伤：135例患者（31%）达到最大急性肾损伤I期，59例（14%）达到II期，31例（7%）达到III期。在多变量分析中，单心室状态（比值比，1.6; 95%置信区间，1.08-2.37; P = 0.02），体外循环（比值比，1.2; 95%置信区间1.01-1.47; P = 0.04），以及较高的参考血清肌酐（比值比，5.1; 95%可信区间，1.94-13.2; P -0.0009）与术后急性肾损伤相关。32例（7%）患者在医院死亡。多因素Logistic回归分析显示，更严重的急性肾损伤与住院死亡率相关（最大急性肾损伤II期比值比，5.1; 95%置信区间，1.7-15.2; P = 0.004;最大急性肾损伤III期比值比，9.46; 95%置信区间，2.91-30.7; P = .0002）和更长时间的机械通气和正性肌力支持。所有急性肾损伤阶段都与较长的重症监护时间相关。第三阶段急性肾损伤与全身心室功能不全在discharse.Conclusions：围手术期急性肾损伤是常见的婴儿心脏手术，并预示着一个不良的临床结果。（《胸血管外科杂志》2012; 143：368-74）
Objectives: We sought to characterize factors and outcomes associated with postoperative acute kidney injury in infants undergoing cardiac surgery.Methods: We retrospectively studied 430 infants (< 90 days) who underwent heart surgery for congenital defects. With a pediatric modified version of the Acute Kidney Injury Network classification, we performed statistical analyses to detect factors and outcomes associated with postoperative acute kidney injury.Results: Postoperative acute kidney injury occurred in 225 patients (52%): 135 patients (31%) reached maximum acute kidney injury stage I, 59 (14%) reached stage II, and 31 (7%) reached stage III. On multivariable analysis, single-ventricle status (odds ratio, 1.6; 95% confidence interval, 1.08-2.37; P = .02), cardiopulmonary bypass (odds ratio, 1.2; 95% confidence interval 1.01-1.47; P = .04), and higher reference serum creatinine (odds ratio, 5.1; 95% confidence interval, 1.94-13.2; P - .0009) were associated with postoperative acute kidney injury. Thirty-two (7%) patients died in the hospital. Multivariable logistic regression showed that more severe acute kidney injury was associated with in-hospital mortality (maximum acute kidney injury stage II odds ratio, 5.1; 95% confidence interval, 1.7-15.2; P = .004; maximum acute kidney injury stage III odds ratio, 9.46; 95% confidence interval, 2.91-30.7; P = .0002) and longer mechanical ventilation and inotropic support. All acute kidney injury stages were associated with longer intensive care durations. Stage III acute kidney injury was associated with systemic ventricular dysfunction at hospital discharge.Conclusions: Perioperative acute kidney injury is common in infant heart surgery and portends a poor clinical outcome. (J Thorac Cardiovasc Surg 2012; 143:368-74)