列线图预测心功能不全患者冠状动脉旁路移植术后急性肾损伤的研究

Establishment of a Prognostic Nomogram to Predict Perioperative Acute Kidney Injury in Heart Failure Patients Undergoing Coronary Artery Bypass Grafting Surgery

目的:建立一个使用简便而准确的列线图预测模型,用于预测心功能不全患者冠状动脉旁路移植术(CABG)后急性肾损伤(AKI)的发生率。方法:连续入选单中心自2012年到2017年间1208例术前左心室射血分数(LVEF)小于50%的心功能不全并行单纯CABG的患者。根据2012年KDIGO共识对于术后AKI的诊断定义,建立一个预测AKI的列线图模型,根据相同的入组标准,从中国心力衰竭外科数据库(China Heart Failure Surgery Registry,China-HFSR)中收集了同期国内几个大心脏中心的患者资料(n=540)进行新模型的外部验证。将新列线图模型与另外3个临床常用的心脏手术术后肾衰竭评分系统(克里夫兰ARF评分、Mehta评分以及SRI评分)进行对比。结果:建模组共1208例患者,其中术后发生AKI的患者共90例(7.5%),新列线图模型纳入了性别、术前血肌酐>2 mg/dl、LVEF<35%、既往心肌梗死病史、高血压、体外循环使用和围术期输血等7个独立的危险因素。其ROC曲线下面积(AUC)为0.738,较其他3个常用模型都高。通过对比各模型的校准曲线(calibration curve),新列线图显示出更好校准度。验证组共540例患者,其中术后发生AKI共104例(19.3%),新列线图模型比其他3个模型显示出更好的区分度和校准度。结论:新列线图模型对于心功能不全患者CABG术后AKI的预测具有更好的准确性和便利度。

Objectives:To establish a model to predict the incidence of acute kidney injury(AKI)after CABG in patients with heart failure(HF).Methods:Clinical information of 1208 consecutive HF patients,who underwent isolated CABG,was collected to establish a derivation cohort.A novel predictive model was developed using the logistic regression to predict postoperative AKI among these patients.The novel model was externally validated and was compared with 3 other available models,which were used to predict renal failure after cardiac surgery.Results:In the derivation cohort,7.5%of patients(n=90)were diagnosed with AKI.The model included independent risk factors of sex,increased Scr,LVEF<35%,history of myocardial infarction(MI),hypertension,cardiopulmonary bypass used and perioperative blood transfusion.The area under the receiver operating characteristic curve(AUC)was higher than the other 3 commonly used models.By comparing calibration curves with other models,the novel model showed better calibration.This model was validated in 540 patients and incidence of AKI was 19.3%(n=104)in this cohort.This novel model performed better than other 3 models in terms of differentiation and calibration.Conclusions:This novel model is reliable to predict postoperative AKI following isolated CABG for patients with heart failure.