PMID- 31365994
OWN - NLM
STAT- MEDLINE
DCOM- 20190903
LR  - 20190903
IS  - 0253-3758 (Print)
IS  - 0253-3758 (Linking)
VI  - 47
IP  - 7
DP  - 2019 Jul 24
TI  - [Risk factors of postoperative acute kidney injury and the impact on outcome in 
      non-senile patients undergoing cardiac valvular surgery].
PG  - 539-543
LID - 10.3760/cma.j.issn.0253-3758.2019.07.006 [doi]
AB  - 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%), chi(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 (chi(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 (chi(2)=0.686, P=0.408) while the hospitalization mortality in 
      patients with AKI stage 2 was higher than those without AKI (chi(2)=8.113, 
      P=0.004). The hospitalization expenses in patients with AKI were 
      10.38(8.59,12.54) x10(4) RMB, significantly higher than that in patients without 
      AKI (9.72(8.03,11.93) x10(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.
FAU - Xie, Z Y
AU  - Xie ZY
AD  - Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy 
      of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou 510080, China.
FAU - Chen, Y H
AU  - Chen YH
AD  - Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy 
      of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou 510080, China.
FAU - Li, Z L
AU  - Li ZL
AD  - Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy 
      of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou 510080, China.
FAU - Chen, S X
AU  - Chen SX
AD  - Division of Preventive Medicine, School of Public Health, Guangzhou Medical 
      University, Guangzhou 510182, China.
FAU - Wu, Y H
AU  - Wu YH
AD  - Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy 
      of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou 510080, China.
FAU - Zhang, K C
AU  - Zhang KC
AD  - Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy 
      of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou 510080, China.
FAU - He, Y N
AU  - He YN
AD  - Department of Nephrology, Daping Hospital, Army Medical University, Chongqing 
      400042, China.
FAU - Huang, J S
AU  - Huang JS
AD  - Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong 
      Cardiovascular Institute, Guangzhou 510080, China.
FAU - Chen, J M
AU  - Chen JM
AD  - Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong 
      Cardiovascular Institute, Guangzhou 510080, China.
FAU - Shi, W
AU  - Shi W
AD  - Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy 
      of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou 510080, China.
FAU - Liang, X L
AU  - Liang XL
AD  - Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy 
      of Medical Sciences, Guangdong Geriatrics Institute, Guangzhou 510080, China.
LA  - chi
GR  - 201604020037/Science and Technology Program of Guangzhou/
GR  - 2016200/Feasible Medical Technology Program for Health and Family Planning 
      Services of Guangdong/
PT  - Journal Article
PL  - China
TA  - Zhonghua Xin Xue Guan Bing Za Zhi
JT  - Zhonghua xin xue guan bing za zhi
JID - 7910682
SB  - IM
MH  - *Acute Kidney Injury
MH  - Adult
MH  - Heart Valves
MH  - Humans
MH  - Length of Stay
MH  - Middle Aged
MH  - Postoperative Complications
MH  - Retrospective Studies
MH  - Risk Factors
OTO - NOTNLM
OT  - Acute kidney injury
OT  - Cardiac valve annuloplasty
OT  - Prognosis
OT  - Risk factors
EDAT- 2019/08/01 06:00
MHDA- 2019/09/04 06:00
CRDT- 2019/08/01 06:00
PHST- 2019/08/01 06:00 [entrez]
PHST- 2019/08/01 06:00 [pubmed]
PHST- 2019/09/04 06:00 [medline]
AID - 10.3760/cma.j.issn.0253-3758.2019.07.006 [doi]
PST - ppublish
SO  - Zhonghua Xin Xue Guan Bing Za Zhi. 2019 Jul 24;47(7):539-543. doi: 
      10.3760/cma.j.issn.0253-3758.2019.07.006.