Objective: To investigate the risk factors of postoperative acute kidney injury (AKI) in patients aged between 40 and 50 years old undergoing cardiac valvular surgery and the impact on outcome. Methods: The clinical data of 286 patients aged between 40 and 50 years old undergoing cardiac valve surgery in Guangdong Provincial People's Hospital from January 2012 to December 2016 were analyzed retrospectively. Preoperative coronary angiography was performed in all patients. All patients enrolled were divided into AKI group and non-AKI group according to the existence or not of postoperative AKI. Patients with AKI were further divided into AKI stage 1, stage 2, and stage 3 groups according to KDIGO guideline. Demographic characteristics, preoperative clinical data including serum creatinine, estimated glomerular filtration rate, hemoglobin, uric acid, urinary protein, presence or absence of chronic kidney disease, left ventricular ejection fraction, pulmonary artery pressure, New York Heart Association (NYHA) functional classification, preoperative co-morbidity (hypertension, diabetes, anemia, cerebrovascular disease, peripheral artery disease), preoperative medication(vasoactive drugs, diuretic, renin-angiotensin system inhibitor (RASI), surgical data (contrast dosage in coronary angiography, type of cardiac valve surgery) were recorded and analyzed in this retrospective study. The risk factors for postoperative AKI and its impact on clinical outcomes (mortality, hospitalization expenses and Intensive Care Unit stay duration) were evaluated. Logistic regression analysis was used to determine the risk factors for postoperative AKI and the adjusted variables with P<0.2 were selected for the multivariate logistic regression analysis to define the independent determinants for AKI. Results: AKI was defined in 106 out of 286 enrolled patients, including 96 patients with AKI stage 1, 10 patients with AKI stage 2 and no patients with AKI stage 3. The proportion of coexisting cerebrovascular diseases was higher in AKI group than in non-AKI group (9(8.49%) and 5(2.78%), χ(2)=4.677, P=0.031), while there was no difference among other baseline data between the two groups. Multivariate logistic regression analysis showed that preoperative complications of cerebral vascular disease was an independent risk factor of postoperative AKI (OR=3.578, 95%CI 1.139-11.242, P=0.029). Five out of 106 AKI patients died during hospitalization while there was only 1 patient died among 180 patients without AKI. Patients with AKI after cardiac valve operation experienced higher mortality than patients without AKI (χ(2)=5.625, P=0.028). Further analysis showed that there was no difference in hospitalization mortality between patients with AKI stage 2 and stage (χ(2)=0.686, P=0.408) while the hospitalization mortality in patients with AKI stage 2 was higher than those without AKI (χ(2)=8.113, P=0.004). The hospitalization expenses in patients with AKI were 10.38(8.59,12.54) ×10(4) RMB, significantly higher than that in patients without AKI (9.72(8.03,11.93) ×10(4) RMB)(P=0.043). There was no difference in hospitalization expenses between patients with AKI stage 1 and without AKI (P=0.635). The hospitalization expenses in patients with AKI stage 2 was higher than those without AKI (P=0.023). Intensive Care Unit stay duration in patients with AKI was 3(1,4) days, significantly higher than those without AKI (P=0.044). There was no difference in Intensive Care Unit stay duration in patients with AKI stage 1 and without AKI (P=0.978), while Intensive Care Unit stay duration in patients with AKI stage 2 was significantly longer than those without AKI (P=0.006). Conclusions: Preoperative complications of cerebral vascular disease is an independent risk factor of postoperative AKI. Non-senile patients with AKI after cardiac valvular surgery is associated with a higher proportion of mortality, hospitalization expenses and Intensive Care Unit stay duration as compared patients without postoperative AKI.
目的： 探讨40~50岁的非老年患者行心脏瓣膜术后发生急性肾损伤（AKI）的危险因素及其对预后的影响。 方法： 回顾性分析2012年1月至2016年12月在广东省人民医院行心脏瓣膜手术的患者共286例，入选者年龄40~50岁，术前均进行了冠状动脉造影，根据心脏瓣膜术后是否发生AKI将入选者分为非AKI组（n=180）和AKI组（n=106），进一步参考改善全球肾脏病预后组织（KDIGO）的指南将AKI组患者分为1、2、3级。记录入选者的人口学资料（年龄和性别）；术前临床资料，包括血肌酐、估算的肾小球滤过率（eGFR）、血红蛋白、尿酸、尿蛋白、是否患有慢性肾脏病、左心室射血分数、肺动脉压力、纽约心脏协会（NYHA）心功能分级；术前伴发症（高血压、糖尿病、贫血、脑血管病、周围动脉疾病）；术前用药情况，包括血管活性药物、利尿剂、肾素-血管紧张素系统抑制剂（RASI）；手术资料（冠状动脉造影术的对比剂用量、心脏瓣膜手术类型）；术后临床预后评估（术后死亡率、重症监护室住院时间、住院总费用）等。分析术后发生AKI的危险因素及AKI对死亡率、住院费用和重症监护室住院时间的影响。采用logistic回归分析分析术后AKI的危险因素，将单因素分析中P<0.2的变量纳入多因素分析。 结果： 纳入的286例患者中发生AKI者共106例（37.06%），其中AKI 1级者96例（33.57%），2级者10例（3.50%），无AKI 3级患者。AKI组患者术前伴发脑血管疾病的比例高于非AKI组[9（8.49%）和5（2.78%），χ(2)=4.677，P=0.031]，其他一般资料两组间差异均无统计学意义。多因素logistic回归分析结果显示，术前合并脑血管疾病是40~50岁非老年患者行心脏瓣膜手术术后发生AKI的危险因素（OR=3.578，95%CI 1.139~11.242，P=0.029）。AKI组106例患者术后住院死亡5例（4.72%），非AKI组180例患者术后住院死亡1例（0.56%），AKI组患者术后住院死亡率高于非AKI组患者（χ(2)=5.625，P=0.028）。进一步分析显示，AKI 2级患者术后住院死亡率与AKI 1级患者比较差异无统计学意义（χ(2)=0.686，P=0.408），但高于非AKI患者（χ(2)=8.113，P=0.004）。AKI组患者住院费用为10.38（8.59，12.54）万元，较非AKI组的9.72（8.03，11.93）万元高（P=0.043）。进一步分析显示，AKI 1级患者住院费用为10.38（8.47，12.36）万元，与非AKI患者比较差异无统计学意义（P=0.635），而AKI 2级患者住院费用为10.87（9.08，19.15）万元，明显高于非AKI患者（P=0.023）。AKI组患者重症监护室住院时间为3（1，4）d，较非AKI组患者的2（1，3）d长（P=0.044）。进一步分析显示，AKI 1级患者重症监护室住院时间为2（1，4）d，与非AKI患者比较差异无统计学意义（P=0.978），而AKI 2级患者重症监护室住院时间为5（2，9）d，明显长于非AKI组（P=0.006）。 结论： 术前合并脑血管疾病可增加40~50岁的非老年心脏瓣膜病患者术后发生AKI的风险，而术后发生AKI可增加住院死亡率和住院费用，并延长重症监护室住院时间。.
Keywords: Acute kidney injury; Cardiac valve annuloplasty; Prognosis; Risk factors.