Long-term survival after cardiac surgery is predicted by estimated glomerular filtration rate
Long-term survival after cardiac surgery is predicted by estimated glomerular filtration rate
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DOI：
10.1016/j.athoracsur.2008.03.006
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发表时间：
2008-07-01
影响因子：
4.6
通讯作者：
O'Connor, Gerald T.
中科院分区：
文献类型：
--
作者：
Brown, Jeremiah R.;Cochran, Richard P.;O'Connor, Gerald T.
背景资料。冠状动脉旁路移植术(CABG)前估计的肾小球滤过率(EGFR)是院内死亡率的关键危险因素。然而，在CABG术前肾功能正常的患者，术后会出现急性肾损伤，因此有必要对术后肾功能进行评估。术后EGFR及其与长期生存的关系尚未得到很好的研究。从2001年到2006年，我们研究了新英格兰北部连续13,593名冠状动脉旁路移植术患者。排除有术前透析的患者。数据被链接到社会保障协会死亡总档案，以评估长期生存。采用Kaplan-Meier法和对数秩法。患者按术后EGFR(90或以上，60~89，30~59，15~29，<15毫升)分类。分钟(-1)。1.73m(-2))。中位随访期为2.8年(0~5.5)，平均2.7年。CABG术后中、重度急性肾损伤(<60分)患者的存活率明显低于轻或无急性肾损伤(90分或以上)的患者。与肾功能正常或接近正常的患者相比，CABG术后中至重度急性肾损伤患者的5年生存率较差。
Background. Estimated glomerular filtration rate (eGFR) before coronary artery bypass graft (CABG) surgery is a key risk factor of in-hospital mortality. However, in patients with normal renal function before CABG, acute kidney injury develops after the procedure, making postoperative renal function assessment necessary for evaluation. Postoperative eGFR and its association with long-term survival have not been well studied.Methods. We studied 13,593 consecutive CABG patients in northern New England from 2001 to 2006. Patients with preoperative dialysis were excluded. Data were linked to the Social Security Association Death Master File to assess long-term survival. Kaplan-Meier and log-rank techniques were used. Patients were stratified by established categories of postoperative eGFR (90 or greater, 60 to 89, 30 to 59, 15 to 29, and less than 15 mL . min(-1) . 1.73 m(-2)).Results. Median follow-up was 2.8 years (mean, 2.7; range, 0 to 5.5). Patients with moderate to severe acute kidney injury (less than 60) after CABG had significantly worse survival than patients with little or no acute kidney injury (90 or greater).Conclusions. Patients having moderate to severe acute kidney injury after CABG surgery had worse 5-year survival compared with patients who had normal or near-normal renal function.