摘要
背景:冠状动脉搭桥术(CABG)后受损的肾脏功能是院内死亡的重要危险因素。然而,围手术期血清肌酐增高及其与死亡率的关系尚未得到很好研究。作者对围手术期血清肌酐增高与90d死亡率增加相关之假设进行评估。方法和结果:对2001年新英格兰北部地区1391例接受CABG的患者进行研究,检测手术前后的血清肌酐浓度。手术前透析患者未纳入本研究。将数据与全国死亡指数相联系以对90d存活情况进行评价。
BACKGROUND -Impaired renal function after coronary artery bypass graft(CABG) surgery is a key risk factor for in-hospital mortality. However, perioperative increases in serum creatinine and the association with mortality has not been well-studied. We assessed the hypothesis that perioperative increases in creatinine are associated with increased 90-day mortality. METHODS AND RESULTS -We studied 1391 patients in northern New England undergoing CABG in 2001 and evaluated preoperative and postoperative creatinine. Patients with preoperative dialysis were excluded. Data were linked to the National Death Index to assess 90-day survival. Kaplan-Meier and log-rank techniques were used. Patients were stratified by percent increase in creatinine from baseline:< 25%, 25%to 49%, 50%to 99%, ≥100%. We assessed 90-day survival and calculated adjusted hazard ratios(HR) and 95%confidence intervals(95%CI) for creatinine groups, adjusting for age and sex. Patients with the largest creatinine increases(50%to 99%or ≥100%) had significantly higher 90-day mortality compared with patients with a smaller increase(< 50%; P< 0.001). Adjusted HR and 95%CI confirmed patients in the higher 2 groups had an increased risk of mortality compared with the< 25%(referent); however, the 25%to 49%group was not different from the referent: 1.80(95%CI: 0.73 to 4.44), 6.57(95%CI, 3.03 to 14.27), and 22.10(95%CI, 11.25 to 43.39). CONCLUSIONS -Patients with large creatinine increases(≥50%) after CABG surgery have a higher 90-day mortality compared with patients with small increases. Efforts to identify patients with impaired renal function and to preserve renal function before cardiac surgery may yield benefits for patients in the future.
