风湿性心脏病瓣膜置换术后严重高胆红素血症合并急性肾损伤患者的不良预后及其危险因素

Long-term prognosis and risk factors in patients underwent heart valve surgery for rheumatic heart disease with severe post-operation hyperbilirubinemia and acute kidney injury

目的分析风湿性心脏病瓣膜置换术严重高胆红素血症合并急性肾损伤患者的不良预后及其危险因素。方法回顾性筛选本院2015年1月至2018年12月行瓣膜置换手术治疗的患者,因风湿性心脏病行瓣膜手术治疗且术后同时发生严重高胆红素血症和急性肾损伤(AKI)的患者被纳入研究。采用单因素和多因素COX回归分析远期死亡相关的危险因素,使用Kaplan-Meier生存曲线来评估患者的长期生存状况。结果120例患者被纳入研究,26例(21.7%)患者接受持续性肾脏替代治疗(CRRT),43例(35.8%)患者住院死亡。1年、2年和3年累积死亡率分别是41%、41.9%和44.5%。多因素COX回归分析显示术中输血量、术后机械通气时长、AKI 2期、AKI 3期、出现胆红素峰值时间是风湿性心脏病瓣膜置换术严重高胆红素血症合并AKI患者远期死亡的独立危险因素。结论术后AKI 2期和3期以及晚发胆红素峰值显著增加了风湿性心脏病瓣膜置换术后严重高胆红素血症合并AKI患者的远期死亡风险。

Objective To investigate the long-term prognosis and risk factors of mortality in rheumatic heart disease(RHD)patients with severe post-operation hyperbilirubinemia and acute kidney injury(AKI)after heart valve surgery.Methods Patients who underwent heart valve surgery for RHD in our center from January 2015 to December 2018 were retrospectively screened.Patients with severe post-operation hyperbilirubinemia and AKI were included in this study.Univariate and multivariate COX analyses were performed to identify the risk factors of long-term mortality.Kaplan-Meier survival curve was employed to assess the long-term mortality of patients.Results One hundred and twenty patients were included,26 of whom(21.7%)received continuous renal replacement therapy(CRRT)and 43(35.8%)died in-hospital.The 1-,2-,and 3-year cumulative mortality were 41%,41.9%,and 44.5%,respectively.Multivariate COX regression analysis showed that total amount of blood transfusion during operation,post-operation mechanical ventilation time,AKI stage 2,AKI stage 3 and time to peak bilirubin were independent risk factors of long-term mortality.Conclusion Post-operation AKI stage 2,stage 3 and late time to peak bilirubin significantly increased the risk of long-term mortality for RHD patients with severe post-operation hyperbilirubinemia and AKI after heart valve surgery.