Cardiac Surgery-Associated Acute Kidney Injury: A Comparison of Two Consensus Criteria
Cardiac Surgery-Associated Acute Kidney Injury: A Comparison of Two Consensus Criteria
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DOI：
10.1016/j.athoracsur.2010.08.018
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发表时间：
2010-11-01
影响因子：
4.6
通讯作者：
Brown, Jeremiah R.
中科院分区：
文献类型：
--
作者：
Robert, Alina M.;Kramer, Robert S.;Brown, Jeremiah R.
背景心脏手术相关的急性肾损伤对患者的进一步发病率和死亡率风险有短期和长期影响。共识声明产生了标准，如风险，损伤，失败，损失，终末期肾病（步枪）标准，急性肾损伤网络（AKIN）标准，以定义急性肾损伤的类型和后果。我们试图评估步枪和AKIN标准预测心脏手术患者院内死亡风险的能力。收集了2001年1月至2007年12月在北方新英格兰接受心脏手术的25,086例患者的数据，排除了339例术前透析患者。使用AKIN和步枪标准对术后患者进行分类，使用术前最后一次和术后最高血清肌酐。比较两种标准的诊断特性，并计算受试者工作特征曲线下的面积。使用AKIN标准的患者中有30%发生急性肾损伤，使用步枪标准的患者中有31%发生急性肾损伤。根据AKIN和步枪标准估计的住院死亡率的受试者工作特征曲线下面积分别为0.79（95%置信区间：0.77至0.80）和0.78（95%置信区间：0.76至0.80）（p = 0.369）。AKIN和步枪标准是准确的死亡率早期预测指标。心脏手术后急性肾损伤的高发生率应促使使用AKIN或步枪标准来识别风险患者，并刺激针对急性肾损伤的机构措施作为质量改进举措。(Ann Thorac Surg 2010;90：1939-43）（C）2010年，胸外科医师协会
Background. Cardiac surgery-related acute kidney injury has short-and long-term impact on patients' risk for further morbidity and mortality. Consensus statements have yielded criteria-such as the risk, injury, failure, loss, and end-stage kidney disease (RIFLE) criteria, and the Acute Kidney Injury Network (AKIN) criteria-to define the type and consequence of acute kidney injury. We sought to estimate the ability of both the RIFLE and and AKIN criteria to predict the risk of in-hospital mortality in the setting of cardiac surgery.Methods. Data were collected on 25,086 patients undergoing cardiac surgery in Northern New England from January 2001 to December 2007, excluding 339 patients on preoperative dialysis. The AKIN and RIFLE criteria were used to classify patients postoperatively, using the last preoperative and the highest postoperative serum creatinine. We compared the diagnostic properties of both criteria, and calculated the areas under the receiver operating characteristic curve.Results. Acute kidney injury occurred in 30% of patients using the AKIN criteria and in 31% of patients using the RIFLE criteria. The areas under the receiver operating characteristic curve for in-hospital mortality estimated by AKIN and RIFLE criteria were 0.79 (95% confidence interval: 0.77 to 0.80) and 0.78 (95% confidence interval: 0.76 to 0.80), respectively (p = 0.369).Conclusions. The AKIN and RIFLE criteria are accurate early predictors of mortality. The high incidence of cardiac surgery postoperative acute kidney injury should prompt the use of either AKIN or RIFLE criteria to identify patients at risk and to stimulate institutional measures that target acute kidney injury as a quality improvement initiative. (Ann Thorac Surg 2010;90:1939-43) (C) 2010 by The Society of Thoracic Surgeons