Introduction: Cardiac surgery-associated acute kidney injury (CSA-AKI) is associated with increased morbidity and mortality. Objectives: We aimed to identify potentially modifiable risk factors for CSA-AKI. Methods: This was asingle-center retrospective cohort study of 495 adult patients undergoing cardiac surgery. AKI was diagnosed and staged using full KDIGO criteria incorporating baseline serum creatinine (SC) levels and correction of postoperative SC levels for fluid balance. We examined the association of routinely available clinical and laboratory data with AKI using multivariate logistic regression modeling. Results: A total of 103 (20.8%) patients developed AKI: 16 (15.5%) patients were diagnosed with AKI upon hospital admission, and 87 (84.5%) patients were diagnosed with CSA-AKI. Correction of SC levels for fluid balance increased the number of AKI cases to 104 (21.0%), with 6 patients categorized to different AKI stages. Univariate logistic regression analysis identified five preoperative (age, sex, diabetes mellitus, preoperative systolic pulmonary arterial pressure [PSPAP], acute decompensated heart failure) and five intraoperative predictors of AKI (age, sex, red blood cell [RBC] volume transfused, use of minimally invasive surgery, duration of cardiopulmonary bypass). When all preoperative and intraoperative variables were incorporated into one model, six predictors remained significant (age, sex, use of minimally invasive surgery, RBC volume transfused, PSPAP, duration of cardiopulmonary bypass). Model discrimination performance showed an area under the curve of 0.69 for the model including only preoperative variables, 0.76 for the model including only intraoperative variables, and 0.77 for the model including all preoperative and intraoperative variables. Conclusions: Use of minimally invasive surgery and therapies mitigating PSPAP and intraoperative blood loss may offer protection against CSA-AKI.
Cardiorenal Med

中文翻译：

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心脏手术后急性肾损伤的临床和手术决定因素。

简介：心脏手术相关的急性肾损伤 (CSA-AKI) 与发病率和死亡率增加有关。目标：我们旨在确定 CSA-AKI 的潜在可改变风险因素。方法：这是一个495 名接受心脏手术的成年患者的单中心回顾性队列研究。AKI 的诊断和分期使用完整的 KDIGO 标准，包括基线血清肌酐 (SC) 水平和术后 SC 水平的体液平衡校正。我们使用多变量逻辑回归模型检查了常规可用的临床和实验室数据与 AKI 的关联。结果：共有 103 名（20.8%）患者发生 AKI：16 名（15.5%）患者在入院时被诊断为 AKI，87 名（84.5%）患者被诊断为 CSA-AKI。体液平衡的 SC 水平校正使 AKI 病例数增加到 104 (21.0%)，其中 6 名患者被归类为不同的 AKI 阶段。单变量逻辑回归分析确定了 5 个术前（年龄、性别、糖尿病、术前收缩期肺动脉压 [PSPAP]、急性失代偿性心力衰竭）和 5 个 AKI 术中预测因子（年龄、性别、红细胞 [RBC] 输注量、使用微创手术、体外循环持续时间）。当所有术前和术中变量合并到一个模型中时，六个预测因素仍然显着（年龄、性别、微创手术的使用、RBC 输注量、PSPAP、体外循环持续时间）。模型辨别性能显示，仅包括术前变量的模型的曲线下面积为 0.69，仅包括术中变量的模型为 0.76，包括所有术前和术中变量的模型为 0.77。结论：使用微创手术和减轻 PSPAP 和术中失血的疗法可能提供对 CSA-AKI 的保护。
心肾医学