The association of acute kidney injury with hospital readmission and death after pediatric cardiac surgery.
The association of acute kidney injury with hospital readmission and death after pediatric cardiac surgery.
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DOI：
10.1016/j.xjon.2020.07.006
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发表时间：
2020-12
期刊：
影响因子：
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通讯作者：
Zappitelli, Michael
中科院分区：
文献类型：
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作者：
Nunes, Sophia;Brown, Jeremiah;Parikh, Chirag R;Greenberg, Jason H;Devarajan, Prasad;Philbrook, Heather Theissen;Pizzi, Michael;Palijan, Ana;Zappitelli, Michael
接受心脏手术 (CS) 的儿童的急性肾损伤 (AKI) 与医院死亡率和住院时间的增加密切相关。 AKI 与出院后结果的关联尚不清楚。我们评估了 AKI 与 CS 出院后 30 天内和 1 年内全因再入院和死亡的关联。这是一项针对体外循环体外循环术后儿童的前瞻性 3 中心队列研究。主要暴露是肾脏疾病定义的术后≥1期AKI和≥2期AKI：改善全球结果AKI定义。两个不同的结果是再次入院和出院 30 天内死亡以及出院 1 年内死亡。使用多变量 Cox 比例风险分析确定 AKI 与时间与结果的关联。年龄、胸外科医生协会-欧洲心胸外科协会风险调整工具评分≥3、体外循环 > 120 分钟和紫绀性心脏病被评估为效果调节剂。在 402 名参与者中（中位年龄 1.8 岁 [四分位距 0.4, 5.2]），32 名 (8.0%) 和 109 名 (27.1%) 重新入院； 7 人 (1.7%) 和 9 人 (2.2%) 分别在 CS 后 30 天内和 1 年内死亡。 AKI 与出院后 30 天或 1 年后的再次入院无关。 ≥2 期 AKI（调整后的风险比，11.68 [1.88，72.61]）与 CS 后 30 天的死亡率相关。术后 AKI 与出院后 30 天和 1 年的再次入院无关。然而，更严重的 AKI（≥ 2 期）似乎与 CS 后 30 天的道德风险增加相关。按 AKI 状态划分的 30 天内再入院的 Kaplan-Meier 曲线。红色虚线代表术后出现 AKI 的患者，蓝色线代表术后未出现 AKI 的患者。红色和蓝色阴影区域分别代表 AKI 和非 AKI 组的置信区间。两条生存曲线之间没有统计学上的显着差异（对数秩检验 P = .065）。
Acute kidney injury (AKI) in children undergoing cardiac surgery (CS) is strongly associated with increased hospital mortality and length of stay. The association of AKI with postdischarge outcomes is unclear. We evaluated the association of AKI with all-cause readmissions and death within 30 days and 1 year of CS discharge. This was a prospective, 3-center cohort study of children after CS with cardiopulmonary bypass. The primary exposures were postoperative ≥stage 1 AKI and ≥stage 2 AKI defined by Kidney Disease: Improving Global Outcomes AKI definition. Two separate outcomes were hospital readmission and death within 30 days and 1 year of discharge. Association of AKI with time to outcomes was determined using multivariable Cox-proportional hazards analysis. Age, The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery risk adjustment tool score ≥3, cardiopulmonary bypass >120 minutes, and cyanotic heart disease were evaluated as effect modifiers. Of 402 participants included (median age 1.8 years [interquartile range 0.4, 5.2]), 32 (8.0%) and 109 (27.1%) were readmitted; 7 (1.7%) and 9 (2.2%) died within 30 days and 1 year of CS, respectively. AKI was not associated with readmission at 30 days or 1 year postdischarge. ≥Stage 2 AKI (adjusted hazard ratio, 11.68 [1.88, 72.61]) was associated with mortality 30 days post-CS. Postoperative AKI was not associated with readmission at 30 days and 1-year postdischarge. However, more severe AKI (≥stage 2) appears to be associated with increased morality risk at 30 days post-CS. Kaplan–Meier curves for readmission within 30 days by AKI status. Red dotted line represents patients with postoperative AKI and blue line represents patients without postoperative AKI. The red and blue-shaded areas represent the confidence intervals for the AKI and non-AKI group respectively. There is no statistically significant difference between the two survival curves (log-rank test P = .065).