Reassessment of Acute Kidney Injury after Cardiac Surgery: A Retrospective Study
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- Xie Xiangcheng
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, China Department of Nephrology, Hangzhou First People's Hospital, Affiliated Hangzhou Hospital of Nanjing Medical University, China
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- Wan Xin
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, China
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- Ji Xiaobing
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, China
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- Chen Xin
- Division of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, China
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- Liu Jian
- Department of Medical Record, Nanjing First Hospital, Nanjing Medical University, China
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- Chen Wen
- Division of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, China
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- Cao Changchun
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, China
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<p>Objective To evaluate the incidence, risk, or protective factors of acute kidney injury (AKI) in patients after cardiac surgery based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. </p><p>Methods A retrospective analysis of 2,575 patients undergoing their first documented cardiac surgery with cardiopulmonary bypass (CPB) was conducted. Perioperative variables were collected and analyzed. Univariate and multiple logistic regression models were used for determining the association between the development of AKI and risk factors. Multiple Cox-proportional hazards modeling was performed to evaluate the impact of AKI on the mortality in the intensive care unit and hospital length of stay. </p><p>Results Of 2,575 patients, 931 (36%) developed AKI. A total of 30 (1.2%) patients required renal replacement therapy. In the multivariate analysis, mechanical ventilation duration (OR1.446, 95% CI 1.195-1.749, p<0.001), CPB duration of ≥110 min (OR 1.314, 95% CI 1.072-1.611, p=0.009), erythrocytes transfusion (OR 1.078, 95% CI 1.050-1.106, p<0.001), and postoperative body temperature greater than 38°C within 3 days (OR 1.234, 95% CI 1.018-1.496, p=0.032) were independent risk factors for CSA-AKI, while ulinastatin use was associated with a reduced incidence of CSA-AKI (OR 0.694, 95% CI 0.557-0.881, p=0.006). CSA-AKI was significantly associated with in-hospital mortality (adjusted HR: 2.218, 95% CI 1.161-4.238, p=0.016), especially in patients needing renal replacement therapy (adjusted HR: 18.683, 95% CI 8.579-40.684, p<0.001). </p><p>Conclusion Mechanical ventilation duration, erythrocytes transfusion, and postoperative body temperature above 38°C within 3 days were considered independent risk factors for CSA-AKI. The use of ulinastatin was associated with a reduced incidence of CSA-AKI. </p>
収録刊行物
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- Internal Medicine
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Internal Medicine 56 (3), 275-282, 2017
一般社団法人 日本内科学会