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目的:观察心脏手术相关急性肾损伤(CSA-AKI)患者的远期存活情况及肾脏转归。方法:本研究纳入2012年1月至2013年12月在南京医科大学第一附属医院住院行心脏手术治疗的患者,按是否发生CSA-AKI分为AKI组与非AKI组,平均随访3年,记录远期生存率及慢性肾脏病(CKD)3期及以上的发病率,并分析其相关影响因素。结果:共纳入1 363例心脏手术患者,CSA-AKI发病率为33.5%。AKI组3年累计生存率低于非AKI组(88.8%vs 97.2%,P<0.001);与非AKI组比,AKI显著增加患者的死亡风险(HR 2.62,95%CI 1.53~4.50);多因素COX回归分析显示,AKI是增加死亡风险的独立危险因素;90d存活的AKI组术后3年CKD 3~5期的发病率高于非AKI组(9.9%vs 2.3%,P<0.001);与非AKI组比,AKI组发生CKD 3~5期的风险增加(HR 3.10,95%CI1.75~5.48);多因素COX回归分析显示,AKI是增加远期CKD 3~5期风险的独立危险因素,高龄、术前估算的肾小球滤过率(e GFR)低也会增加远期CKD 3~5期风险。结论:CSA-AKI显著增加患者术后3年的死亡风险和CKD 3~5期发病率。需重视CSA-AKI的防治,并加强肾功能的长期随访,以改善患者的远期预后。
Objective: To observe the long-term survival and renal outcome of patients with acute renal injury (CSA-AKI) undergoing cardiac surgery. Methods: The patients enrolled in the First Affiliated Hospital of Nanjing Medical University from January 2012 to December 2013 were divided into AKI group and non-AKI group according to whether CSA-AKI occurred or not. The patients were followed up for an average of 3 years, Record the long-term survival rate and the incidence of chronic kidney disease (CKD) stage 3 and above, and analyze the related factors. Results: A total of 1 363 patients undergoing cardiac surgery were enrolled. The incidence of CSA-AKI was 33.5%. The 3-year cumulative survival rate in AKI group was lower than that in non-AKI group (88.8% vs 97.2%, P <0.001); AKI significantly increased the risk of death (HR 2.62, 95% CI 1.53-4.50) compared with non-AKI group Factors COX regression analysis showed that AKI was an independent risk factor for increasing the risk of death. The incidence of CKD stage 3 to 5 in 3 - year survival was higher in AKI group than in non - AKI group (9.9% vs 2.3%, P <0.001). Compared with the non-AKI group, the risk of CKD stages 3-5 in the AKI group increased (HR 3.10, 95% CI 1.75-5.48). Multivariate COX regression analysis showed that AKI was independent of the risk of increasing stage 3-5 of forward CKD Risk factors, advanced age, and preoperatively estimated low glomerular filtration rate (e GFR) also increase the risk of stage 3-5 CKD. CONCLUSIONS: CSA-AKI significantly increases the 3-year postoperative mortality risk and the incidence of stage 3-5 CKD. Attention should be paid to the prevention and treatment of CSA-AKI, and to strengthen the long-term follow-up of renal function in order to improve the long-term prognosis of patients.