Analysis Of Risk Factors In Postoperative Patients With Acute Kidney Injury Undergoing On-pump Beating Heart Coronary Artery Bypass Grafting And Evaluation Of Risk

Objective:Analysis of risk factors in postoperative patients with acute kidney injury undergoing on-pump beating heart coronary artery bypass grafting and evaluation of risk.Method:90 consecutive patients underwent on-pump beating heart coronary artery bypass grafting from January 1st 2015 to December 31 st 2016 in cardiac surgery center of Beijing Anzhen Hospital of Capital Medical University were selected.Exclusion criteria:(1)the age<18;(2)preoperative renal replacement therapy;(3)lack of medical record data;(4)patients died during the operation.According to the diagnostic criteria from Kidney Disease: Improving Global Outcomes(KDIGO),all cases were divided into AKI group(n=29)and non-AKI group(n=61),Compared the clinic features between two groups,patients' clinic data was entered database,T-test,U-test,?2-test and logistic regression analysis were performed to identify the independent risk factors of postoperative AKI.According to the related risk factors,a risk prediction evaluation system was carried out.Result:There were 29 cases(29/90,32.2%)with AKI in the postoperative group.Age,hypertension,left ventricular ejection fraction(LVEF or EF),estimated glomerular filtration rate(eGFR),intraoperative hypotension duration>60min,cardiopulmonary bypass(CPB)time>120min,number of graft vessels,the amount of bleeding,postoperative hypotension duration>60min,mechanical ventilation time>40hours,the application of intra-aortic balloon pump(IABP)are risk factors of postoperativeAKI.Logistic regression analysis demonstrates that LVEF(%),CPB time>120min,intraoperative hypotension duration>60min were independent risk factors for postoperative AKI respectively.The variable data was grouped and logistic multivariate regression was performed.The score system was as follows: age?65years old for 2 points;LVEF <45% for 3 points,45%?LVEF<50 % for 2 points,50% ? LVEF<55% for 1 point;CPB time> 120 min for 2 points;hypotension duration > 60 min for 1point;mechanical ventilation time>40hours for 3 points;IABP application for 1point;preoperative,eGFR under 100 mL/(min·1.73m2),every20 mL/(min·1.73m2)decrease for 1 points.Total score is 15 points.Conclusion:LVEF(%),CPB time>120min,intraoperative hypotension duration>60min were independent risk factors for AKI respectively.By analyzing the clinic data,a clinical predictive score system for postoperative AKI after on-pump beating heart coronary artery bypass grafting was established.