Prediction of acute kidney injury after cardiac surgery from preoperative N-terminal pro-B-type natriuretic peptide,British Journal of Anaesthesia

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Prediction of acute kidney injury after cardiac surgery from preoperative N-terminal pro-B-type natriuretic peptide
British Journal of Anaesthesia ( IF 9.8 ) Pub Date : 2021-09-22 , DOI: 10.1016/j.bja.2021.08.015
Chunrong Wang ₁ , Yuchen Gao ₁ , Yu Tian ₁ , Yuefu Wang ₂ , Wei Zhao ₃ , Daniel I Sessler ₄ , Yuan Jia ₁ , Bingyang Ji ₅ , Xiaolin Diao ₃ , Xinyi Xu ₃ , Jianhui Wang ₁ , Jun Li ₁ , Sudena Wang ₁ , Jia Liu ₁

Affiliation

Background

Acute kidney injury (AKI) is common after cardiac surgery and is difficult to predict. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is highly predictive for perioperative cardiovascular complications and may also predict renal injury. We therefore tested the hypothesis that preoperative NT-proBNP concentration is associated with renal injury after major cardiac surgery.

Methods

We included 35 337 patients who had cardiac surgery and measurements of preoperative NT-proBNP and postoperative creatinine. The primary outcome was Kidney Disease: Improving Global Outcomes Stages 1–3 AKI. We also separately considered severe AKI, including Stage 2, Stage 3, and new-onset dialysis.

Results

Postoperative AKI occurred in 11 999 (34.0%) patients. Stage 2 AKI occurred in 1200 (3.4%) patients, Stage 3 AKI in 474 (1.3%) patients, and new-onset dialysis was required in 241 (0.7%) patients. The NT-proBNP concentrations (considered continuously or in quartiles) were significantly correlated with any-stage AKI and severe AKI (all adjusted P<0.01). Including NT-proBNP significantly improved AKI prediction (net reclassification improvement: 0.24 [0.22−0.27]; P<0.001) beyond basic models derived from other baseline factors in the overall population. Reclassification was especially improved for higher grades of renal injury: 0.30 (0.25−0.36) for Stage 2, 0.46 (0.37−0.55) for Stage 3, and 0.47 (0.35−0.60) for dialysis.

Conclusions

Increased preoperative NT-proBNP concentrations were associated with postoperative AKI in patients having cardiac surgery. Including NT-proBNP substantially improves AKI predictions based on other preoperative factors.

中文翻译：

术前N端前B型利钠肽对心脏手术后急性肾损伤的预测

背景

急性肾损伤 (AKI) 在心脏手术后很常见，并且难以预测。N 端 B 型利钠肽原 (NT-proBNP) 对围手术期心血管并发症具有高度预测性，也可预测肾损伤。因此，我们检验了术前 NT-proBNP 浓度与心脏大手术后肾损伤相关的假设。

方法

我们纳入了 35337 名接受过心脏手术的患者，并测量了术前 NT-proBNP 和术后肌酐。主要结果是肾脏疾病：改善 1-3 期 AKI 的全球结果。我们还分别考虑了重度 AKI，包括第 2 阶段、第 3 阶段和新发透析。

结果

术后 AKI 发生在 11 999 (34.0%) 名患者中。1200 名 (3.4%) 患者发生 2 期 AKI，474 名 (1.3%) 患者发生 AKI 3 期，241 名 (0.7%) 患者需要新发透析。NT-proBNP 浓度（连续或四分位数考虑）与任何阶段的 AKI 和严重 AKI 显着相关（所有调整后的P <0.01）。包括 NT-proBNP 在内的 AKI 预测显着改善（净重分类改善：0.24 [0.22-0.27]；P <0.001）超出了总体人群中其他基线因素得出的基本模型。对于更高级别的肾损伤，重新分类得到特别改善：第 2 阶段为 0.30 (0.25-0.36)，第 3 阶段为 0.46 (0.37-0.55)，透析为 0.47 (0.35-0.60)。