冠脉搭桥术后发生早期急性肾损伤的风险评估

Risk assessment of early acute kidney injury after coronary artery bypass grafting

摘要:

目的 研究血红蛋白-红细胞分布宽度比值（hemoglobin / red blood cell distribution width ratio，HRR）与冠脉搭桥手术（coronary artery bypass grafting，CABG）后急性肾损伤（acute kidney injury，AKI）发生风险的相关性。方法 选择重症监护数据集（Medical Information Mart for Intensive Care Database，MIMIC）-Ⅳ中所有CABG术后患者作为研究对象，根据是否发生AKI分为2组。比较分析2组一般资料，并将有统计学差异的变量纳入logistic单因素回归分析，以单因素分析中P<0.05的变量纳入多因素logistic回归分析。Logistic回归模型评估HRR对CABG术后AKI风险的预测价值。亚组分析采用层次回归模型。结果 共5 623例患者纳入研究，AKI组4 342例，非AKI组1 281例。AKI组患者入院时HRR水平明显低于非AKI组（P<0.001）。多因素回归模型显示HRR是预测CABG术后AKI风险的独立危险因子（OR=0.92，95%CI=0.88~0.96，P<0.001）。Logistic回归模型发现，在模型Ⅲ中（调整潜在混杂因素），HRR水平降低仍然是CABG术后发生AKI的独立影响因素。亚组分析发现HRR与AKI发生的相关性在大多数协变量中相似。结论 低HRR水平是CABG术后AKI发生风险的独立危险因素。

Abstract:

Objective To investigate the association between the hemoglobin / red blood cell distribution width ratio（HRR）and early acute kidney injury（AKI）after coronary artery bypass grafting（CABG）.Methods All patients were enrolled from the Medical Information Mart for Intensive Care Database（MIMIC）-Ⅳ. The patients were divided into 2 groups according to whether AKI occurred. The general data of the 2 groups were compared and analyzed，the variables with statistical difference were included in logistic univariate regression analysis，and variables with P<0.05 were included in multivariate logistic regression analysis. Logistic regression model was used to evaluate the predictive value of HRR for AKI risk after CABG. Stratified regression model was used for subgroup analysis.Results A total of 5 623 patients were enrolled in the study，including 4 342 cases in the AKI group and 1 281 cases in the non-AKI group. The HRR level at admission in AKI group was significantly lower than that in non-AKI group（P<0.001）. Multivariate regression model showed that HRR was an independent risk factor for AKI after CABG（OR=0.92，95%CI=0.88-0.96，P<0.001）. Logistic regression model showed that in model Ⅲ（adjusting for potential confounders），low HRR level was still an independent influencing factor for AKI after CABG. Subgroup analysis found that the association between HRR and AKI was similar in most covariates.Conclusion Low HRR level is an independent risk factor for AKI after CABG.