【罂粟摘要】血清肌酐早期变化与心脏手术后30天死亡率相关:队列研究
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血清肌酐早期变化与心脏手术
后30天死亡率相关:队列研究
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急性肾损伤预示了心脏手术后的不良后果。
确定心脏手术后超短期内血清肌酐(SCrea)水平的变化(120分钟内)是否可预测患者的临床结局(30天死亡率)。
观察性队列研究。
7651名计划接受择期心脏手术的患者。
我们分析了术前(基线)和手术后120分钟内测得的SCrea水平。我们还调整了术后SCrea水平以排除液体正平衡的影响。根据术前和术后SCrea水平(△SCreaAdmICU)之间的差异对患者分组。我们进行了单变量和多变量分析,以确定SCrea水平变化与30天死亡率之间的关联。
心脏手术后,SCrea水平下降了5923例,而上升了1728例。SCrea水平升高与30天死亡率增加21%有关。即使SCrea的增加值很小(0至<26.5umol/l-1)也与30天死亡率显着相关[危险比(HR),1.98;95%置信区间(CI)为1.54至2.55;P <0.001]。调整液体平衡(按体积进行调整)后上述关联加强(从0增加到<26.5umol/l-1:HR,1.78。95%CI,1.40至2.26;P <0.001;增加≥26.5umol/l-1:HR,2.40;95%CI,1.68至3.42;P <0.001)。
心脏手术后,超短期内即使SCrea水平仅有极微小的增加,也会增加术后30天死亡率。流液体平衡的调整加强了这种联系。基线和转入重症监护病房(DSCreaAdmICU)后SCrea峰值水平之间的变化可以作为心脏手术后早期危险分层的一种简单、便宜且可广泛使用的指标。
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Very early changes in serum creatinine are associated with 30-day mortality after cardiac surgery A cohort study
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BACKGROUND: Acute kidney injury predicts adverse outcomes after cardiac surgery.
OBJECTIVES: To determine whether ultra-short-term changes (within 120 min) in serum creatinine (SCrea) levels after cardiac surgery predict clinical outcomes (30-day mortality).
DESIGN: Observational cohort study.
SETTING: Austrian tertiary referral centre.
PATIENTS: A total of 7651 patients scheduled to undergo elective cardiac surgery.
MAIN OUTCOME MEASURES: We analysed SCrea levels measured pre-operatively (baseline) and within 120 min after surgery. We also adjusted the postoperative SCrea levels for fluid balance. Patients were grouped according to the difference between the pre and postoperative SCrea levels(DSCreaAdmICU). We performed univariable and multivariable analyses to determine the association between changes in SCrea levels and 30-day mortality.
RESULTS: After cardiac surgery, the SCrea level decreased in 5923 patients and increased in 1728 patients. Increased SCrea levels were associated with a 21% increase in 30-day mortality. Even minimal increases in SCrea (0 to<26.5umol/l-1) were significantly associated with 30-day mortality [hazard ratio (HR), 1.98; 95% confidence interval(CI), 1.54 to 2.55; P<0.001]. Adjustments for fluid balance strengthened the above association (increases of 0 to <26.5umol/l-1: HR, 1.78; 95% CI, 1.40 to 2.26;P<0.001; increases of at least 26.5umol/l-1: HR, 2.40;95% CI, 1.68 to 3.42; P<0.001).
CONCLUSION: Even minimal, ultra-short-term increases in SCrea levels after cardiac surgery are associated with increased 30-day mortality. Adjustment for fluid balance strengthens this association. The change in SCrea between baseline and after admission to the Intensive Care Unit(DSCreaAdmICU) can serve as a simple, cheap and widely available marker for very early risk stratification after cardiac surgery.
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翻译:牛振瑛
编辑:佟睿
审核:曹莹
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