Postoperative Fluid Overload is a Useful Predictor of the Short-Term Outcome of Renal Replacement Therapy for Acute Kidney Injury After Cardiac Surgery.
Postoperative Fluid Overload is a Useful Predictor of the Short-Term Outcome of Renal Replacement Therapy for Acute Kidney Injury After Cardiac Surgery.
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DOI：
10.1097/md.0000000000001360
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发表时间：
2015-08
期刊：
影响因子：
1.6
通讯作者：
Teng J
中科院分区：
文献类型：
--
作者：
Xu J;Shen B;Fang Y;Liu Z;Zou J;Liu L;Wang C;Ding X;Teng J
分析肾脏替代治疗（RRT）对心脏手术后急性肾损伤（阿基）患者术后液体超负荷（PFO）的预测价值。收集了2005年1月至2012年4月期间280名心脏手术患者的数据进行回顾性分析。采用受试者工作特征（ROC）曲线比较术后不同时间累积PFO对90天死亡率的预测值。RRT开始前的累积PFO为7.9% ± 7.1%，中位PFO为6.1%。 在重症监护室（ICU）开始RRT前后，死亡组的累积PFO高于存活组（8.8% ± 7.6% vs 6.1% ± 5.6%，P = 0.001; −0.5[−5.6，5.1]% vs 6.9[2.2，14.6]%，P <0.001）。 在整个ICU期间的累积PFO为14.3% ± 15.8%，中位PFO为10.7%。 根据24小时PFO、RRT开始前后累积PFO和术后整个ICU期间PFO预测90天死亡率的ROC曲线下面积分别为0.625、0.627、0.731和0.752。 以整个ICU期间PFO ≥7.2%作为90天死亡率预测的临界点，敏感性为77%，特异性为64%。Kaplan-Meier生存评估显示心脏手术后累积PFO≥ 7.2%和PFO <7.2%患者的生存率有显著差异（对数秩P<0.001）。 术后整个ICU住院期间累积PFO ≥7.2%将对90天短期结局产生不良影响，这可能为心脏手术后AKI-RRT患者的容量控制提供策略。
To analyze the predictive value of postoperative percent fluid overload (PFO) of renal replacement therapy (RRT) for acute kidney injury (AKI) patients after cardiac surgery. Data from 280 cardiac surgery patients between 2005 January and 2012 April were collected for retrospective analyses. A receiver operating characteristic (ROC) curve was used to compare the predictive values of cumulative PFO at different times after surgery for 90-day mortality. The cumulative PFO before RRT initiation was 7.9% ± 7.1% and the median PFO 6.1%. The cumulative PFO before and after RRT initiation in intensive care unit (ICU) was higher in the death group than in the survival group (8.8% ± 7.6% vs 6.1% ± 5.6%, P = 0.001; −0.5[−5.6, 5.1]% vs 6.9[2.2, 14.6]%, P < 0.001). The cumulative PFO during the whole ICU stay was 14.3% ± 15.8% and the median PFO was 10.7%. The areas under the ROC curves to predict the 90-day mortality by PFO at 24 hours, cumulative PFO before and after RRT initiation, and PFO during the whole ICU stay postoperatively were 0.625, 0.627, 0.731, and 0.752. PFO during the whole ICU stay ≥7.2% was determined as the cut-off point for 90-day mortality prediction with a sensitivity of 77% and a specificity of 64%. Kaplan–Meier survival estimates showed a significant difference in survival among patients with cumulative PFO ≥ 7.2% and PFO < 7.2% after cardiac surgery (log-rank P < 0.001). Postoperative cumulative PFO during the whole ICU stay ≥7.2% would have an adverse effect on 90-day short-term outcome, which may provide a strategy for the volume control of AKI-RRT patients after cardiac surgery.