冠状动脉旁路移植术后急性肾损伤的危险因素分析以及预测模型的建立

Analysis of Risk Factors and the Establishment of Prediction Model for Acute Kidney Injury after Coronary Artery Bypass Grafting

摘要: 目的：急性肾损伤(Acute Kidney Injury, AKI)是冠状动脉旁路移植术(Coronary Artery Bypass Grafting, CABG)后常见的并发症。本研究旨在探讨CABG后发生AKI的危险因素并建立风险预测模型，以便早期识别高危患者。方法：本研究共随访2018至2020年期间接受CABG治疗的患者1253例，根据术后是否发生AKI并分为AKI组和non AKI组。根据肾脏疾病改善全球结局(KDIGO)标准定义AKI，并采用Logistic回归对分析变量进行统计学分析。结果：本研究共纳入1190例患者，其中AKI组295例，non AKI组895例。研究显示CABG术后AKI的发生率为24.7%。多因素logistic回归分析显示，预估肾小球滤过率(eGFR)、尿酸、高血压、急诊手术、心力衰竭、术中输血、使用主动脉内球囊反搏(IABP)，术后应用肾上腺素是术后AKI的独立危险因素，同时利用上述危险因素构建术后AKI的预测模型，ROC分析显示AUC = 0.707，95%CI 0.671~0.742。该模型具有良好的预测效果。结论：我们得出了8个术后AKI的危险因素，并建立了预测模型，早期对这些危险因素实施临床干预可能更有利于降低AKI发生的风险。

Abstract: Objective: Acute kidney injury (AKI) is a common complication of coronary artery bypass grafting (CABG). This study aimed to explore the risk factors for AKI after coronary artery bypass grafting and to establish a risk prediction model for early identification of relevant risk factors and inter-ventions. Methods: A total of 1253 patients who underwent CABG between 2018 and 2020 were included and divided into AKI and non-AKI groups according to whether AKI occurred after surgery. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The analysis variables were statistically calculated using logistic regression. Results: A total of 1190 patients, 295 and 895 patients in the AKI and non-AKI groups, respectively, were included in this study. The incidence of AKI after CABG was 24.7%. Multivariate logistic regression analysis showed that estimated glomerular filtration rate (eGFR), uric acid, hypertension, emergency surgery, heart failure, intraoperative blood transfusion, use of an intra-aortic balloon pump (IABP), and postoperative adrenaline were independently associated with AKI after CABG. A nomogram of postoperative AKI in patients was constructed using total predictor variables (AUC = 0.707, 95%CI 0.671~0.742). Conclusion: We developed and validated 8 risk factors for predicting AKI after CABG. Early implementation of clinical intervention for these risk factors may be more beneficial to re-ducing the risk of AKI.