| Objective: Acute kidney injury(AKI)is a common complication of cardiac surgery that usually results in worse prognosis.Studies have shown that recombinant human brain natriuretic peptide(rh-BNP)can reduce the myocardial damage,renal injury and other adverse effects after cardiac surgery in patients.However,the treatment effects of rh-BNP for AKI in patients underwent cardiac surgery are unclear.This study was aimed to explore the curative effects of postoperative application of rh-BNP on cardio-renal function in patients underwent off-pump coronary artery bypass grafting(OPCABG)by observing imaging and laboratory indicators,Which may provide new clinical ideas for the application of rh-BNP after cardiac surgery.Methods: This study included patients diagnosed with AKI after OPCABG at the period of January 2016 to December 2020.All patients were divided into rh-BNP group(observation group)and non rh-BNP group(control group),respectively,according to whether rh-BNP was received intravenously within 4 days after the operation.The targeted observation indexes included the changing trend of postoperative left ventricular ejection fraction(LVEF),the decreasing trend of postoperative creatinine within 4 days,the total urine volume within 4 days,the total dose of diuretic within 4 days and the allcause death of patients within 7 days in the hospital.The clinical baseline information of patients was analyzed by linear regression and logistic regression to adjust the confounding effects between clinical characteristics and rh-BNP.At the same time,Standardized Mean Difference(SMD)in all patient characteristics was analyzed by R studio.Propensity score matching(PSM)was used to perform a sensitivity analysis.Meanwhile,Love plot was used to display the SMD before and after Propensity Score Matching.Match It package for PSM was used in R studio with a caliper value of 0.05,and the method was nearest neighbor.The study population was selected by the ratio of1:4 in observation group and control group.Results:1.A total of 387 patients were enrolled in the study based on the exclusion and diagnostic criteria.The stepwise linear regression and Logistic multivariate regression showed that decreasing trend of postoperative serum creatinine levels(P<0.001),postoperative urine volume(P<0.001)within 4 days of surgery and the postoperative trend of LVEF(P=0.036)were independently associated with rh-BNP,and there was no significant difference in cumulative dosage of diuretic and mortality in the application of rh-BNP.2.Sensitivity analysis was performed by PSM.All baseline data were not statistically different between the two groups after PSM.a total of 181 patients were included in this study,including 45 patients in the BNP group and 136 patients in nonBNP group.The results showed that the decreased trend of postoperative creatinine levels was significantly higher in the rh-BNP group than in the non rh-BNP group(2.0±30.9 vs-17.4±26.7,P<0.001),the urine volume was higher than in the non rh-BNP group(1.2±2.7 vs 9.1±2.9,P<0.001),and the LVEF upward trend was higher in the BNP group than in the non rh-BNP group(1.2±3.6 vs-0.9±5.3,P=0.01).There was no significant difference in cumulative dosage of diuretic(P=0.951)and mortality(P=0.212)between the two groups.Conclusion: Rh-BNP can improve the decreasing trend of serum creatinine levels,increase the urine volume,and improve the ejection fraction of the patients with AKI,which have positive effects on the postoperative recovery of cardio-renal function of patients after OPCABG. |
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