摘要
目的探讨心脏瓣膜置换术相关急性肾损伤(AKI)患者进展至慢性肾脏病(CKD)的危险因素。方法该研究为巢式病例对照研究。回顾性纳入2018年1月1日至2020年12月31日于阜外华中心血管病医院行心脏瓣膜置换术,既往无CKD且术后发生AKI的患者。出院后随访至少90 d,研究终点为AKI发生90 d后进展为CKD,按是否发生终点事件分为CKD组和非CKD组,比较两组患者临床资料的差异。非正态分布的计量资料采用M(Q_(1),Q_(3))表示;采用logistic回归模型分析心脏瓣膜置换术相关AKI进展至CKD的危险因素,用受试者工作特征(ROC)曲线下面积评价模型效能。结果共纳入149例心脏瓣膜置换术相关AKI患者,男86例,女63例,年龄(59.0±10.2)岁,其中27例(18.1%)患者在AKI发生后90 d进展为CKD。与非CKD组相比,CKD组患者年龄较大[66(58,70)比59(53,64)岁],基线估算肾小球滤过率(eGFR)较低[76.3(65.8,98.5)比92.7(78.5,101.6)ml·min^(-1)·(1.73 m^(2))^(-1)],术前合并高血压比例较高[51.9%(14/27)比27.9%(34/122)],出院时血肌酐较高[136(101,165)比86(65,104)μmol/L],差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,年龄较大(OR=1.063,95%CI:1.001~1.129,P=0.047)、术前合并高血压(OR=3.070,95%CI:1.105~8.532,P=0.031)及出院时血肌酐较高(OR=1.026,95%CI:1.013~1.038,P<0.001)是心脏瓣膜置换术相关AKI患者进展至CKD的危险因素。由年龄、术前合并高血压、术前eGFR和出院时血肌酐建立的风险模型ROC曲线下面积为0.865(95%CI:0.790~0.940,P<0.001)。结论年龄较大、术前合并高血压及出院时血肌酐较高是心脏瓣膜置换术相关AKI患者进展至CKD的危险因素。
Objective To explore the risk factors for progression to chronic kidney disease(CKD)in patients with cardiac valve replacement surgery-associated acute kidney injury(AKI).Methods A retrospective,nested case-control study was conducted at Fuwai Central China Cardiovascular Hospital.The study subjects were patients who underwent cardiac valve replacement surgery from January 1,2018 to December 31,2020,with a baseline estimated glomerular filtration rate(eGFR)>60 ml·min^(-1)·(1.73 m^(2))^(-1) and postoperative complication of AKI.The patients were followed up for 90 days after discharge from hospital.The endpoint event was defined as progression to CKD 90 days after the occurrence of cardiac valve replacement surgery-associated AKI.The patients were divided into CKD group and non-CKD group based on whether they experienced endpoint event.The baseline clinical data were compared between the two groups.The measurement data with non-normal distribution was represented as M(Q_(1),Q_(3)).Logistic regression model was used to analyze the risk factors of endpoint event.The receiver-operating characteristic(ROC)curve was drawn to evaluate the performance for predicting CKD in cardiac valve replacement surgery-associated AKI patients.Results A total of 149 cardiac valve replacement surgery-associated AKI patients(86 males and 63 females)were included in the study,aged(59.0±10.2)years.There were 27 patients(18.1%)who progressed to new-onset CKD 90 days after the occurrence of cardiac valve replacement surgery-associated AKI.Compared with non-CKD group,patients in CKD group had older age[66(58,70)vs 59(53,64)years],lower baseline eGFR[76.3(65.8,98.5)vs 92.7(78.5,101.6)ml·min^(-1)·(1.73 m^(2))^(-1)],higher proportion of preoperative hypertension[51.9%(14/27)vs 27.9%(34/122)]and serum creatinine at discharge[136(101,165)vs 86(65,104)μmol/L],and the differences were statistically significant(all P<0.05).The multivariate logistic regression analysis results revealed that older age(OR=1.063,95%CI:1.001-1.129,P=0.047),preoperative hypertension(OR=3.070,95%CI:1.105-8.532,P=0.031)and higher serum creatinine at discharge(OR=1.026,95%CI:1.013-1.038,P<0.001)were risk factors for progression to CKD in patients with cardiac valve replacement surgery-associated AKI.The clinical risk model including age,preoperative hypertension,preoperative baseline eGFR,and serum creatinine at discharge produced a moderate performance for predicting progression to CKD in patients with cardiac valve replacement surgery-associated AKI[the area under the curve(AUC)=0.865,95%CI:0.790-0.940,P<0.001].Conclusion Older age,preoperative hypertension and higher serum creatinine at discharge are risk factors for progression to CKD in patients with cardiac valve replacement surgery-associated AKI.
作者
范晓光
尤针针
王山
霍帅
朱梦远
阎磊
顾玥
邵凤民
Fan Xiaoguang;You Zhenzhen;Wang Shan;Huo Shuai;Zhu Mengyuan;Yan Lei;Gu Yue;Shao Fengmin(Department of Nephrology,Fuwai Center China Cardiovascular Hospital,Henan Provincial People′s Hospital,Henan Provincial Clinical Research Center for Kidney Disease,Henan Key Laboratory of Nephrology and Immunology,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 451464,China;Department of Cardiology,Fuwai Center China Cardiovascular Hospital,Henan Provincial People′s Hospital Heart Center,Henan Institute of Cardiovascular Epidemiology,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 451464,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2024年第24期2222-2228,共7页
National Medical Journal of China
基金
河南省卫生健康委员会医学科技攻关项目(LHGJ20220116)
关键词
心脏瓣膜疾病
急性肾损伤
慢性肾脏病
危险因素
Heart valve diseases
Acute kidney injury
Chronic kidney disease
Risk factors
