| Background: Acute kidney injury(AKI)is one of the serious complications for patients accepted cardiac surgery.Depending on the definition,the incidences of cardiac surgery-associated AKI(CSA-AKI)varied between 7% and 40%.And,CSA-AKI is independently associated with increased mortality.Although the technology of cardiac surgery had been significantly improved,1%-2% patients developed severe AKI and had to accept renal replacement therapy(RRT).And,the mortality of these patients was significantly increased(ranged from 40% to 90%).Therefore,it is important to identify the risk factors of death and renal outcome in CSA-AKI patients needed RRT.There were several studies has identified the preoperative risk factors and established predicting model for CSA-AKI or RRT-dependent CSA-AKI in patients underwent cardiac surgery.However,the risk factors of mortality and renal survival in CSA-AKI patients who had RRT have not been well identified.Furthermore,only a fewer studies reported the long term renal outcome and the risk factors of long term renal outcome.Clinicians need more evidences to understand the short-term outcome,need to know the risk factors of patient outcome,need predicting model to estimate the short-term outcome,and need more data to ecaluate the long-term outcome in CSA-AKI patients who accepted RRT.Objectives: The purpose of our present study is to report the short-term and long-term outcome of CSA-AKI patients who had continuous renal replacement therapy(CRRT)and identify the risk factors of short-term and long-term outcome.Additionally,our present study tried to establish a predicting model of the short-term outcome and verify the efficacy of our predicting model in a new cohort in CSA-AKI patients who had CRRT.Methods: We included adult CSA-AKI patients who required RRT in our center between November 2010 and March 2015.And,the preoperative,intraoperative,postoperative clinical parameters,RRT data,and renal recovery of the included patients were collected.Patients who survived and patients whose renal functions recovered were considered an RRT success,whereas patients who died or who were RRT dependent were considered an RRT failure.Univariate and multivariate logistic regression model was employed to identify the risk factors and build the predicting model.Additionally,we screened the CSA-AKI patients who had RRT in our center between April 2015 and March 2018 according to the aforementioned patient selection criteria to validate our predicting model.ROC was employed to assess the efficacy of our predicting model.In order to observe the long-term outcome of CSA-AKI patients who had RRT,we followed-up the included pateints between November 2010 and March 2015 for additional three months.Renal recovery was defined as remaining alive and free of RRT for 14 consecutive days.Univariate and multivariate logistic analyses were employed to identify the risk factors of renal recovery in 3 months after the cardiac surgery.Results: In the first part,we included 190 adult post-cardiac surgery patients who had AKI and required RRT as Model establishment cohort.Of these patients,87 had in-hospital RRT success,whereas 103 patients had RRT failure(70 deaths and 33 cases of RRT dependence).The multivariate logistic analysis demonstrated that old age(HR: 1.042,CI: 1.012–1.074;P = 0.011],serum uric acid(HR: 1.015,95% CI: 1.003–1.031;P = 0.024),intraoperative concentrated red blood cell transfusions(HR: 1.144,95% CI: 1.006–1.312;P = 0.041),postoperative low cardiac output syndrome(HR: 3.107,95% CI: 1.179–8.190;P = 0.022),and multiple organ failure(OR: 5.786,95% CI: 2.115–15.832;P = 0.001)were factors associated with increased RRT failure risk.Additionally,we built a prediction model based on the results of multivariate analysis.The prediction model(-4.3 + 0.002_preuric acid + 0.10_concentrated red blood cells + 0.04_age + 1.12_[low cardiac output syndrome = 1] + 1.67_[multiple organ failure = 1])had statistically significant predictive power with an area under the curve of 0.786.In order to validate the predicting model,192 CSA-AKI patients who had CRRT in our center between April 2015 and March 2018 were included.And,the above indicators were included in the model equation for ROC analysis.The area under the curve =0.814,95% CI = 0.752-0.876,p<0.001.In order to observe the long-term outcome of CSA-AKI patients who needed RRT,the second part of our paper included 185 patients with average age 50.2 ± 13.1 years.Of the included patients,67.6% were male and the pre-operation average e GFR was 78.5(44.7-82.0)ml/min/1.73m2.During the follow-up duration,95 patients(51.4%)had renal recovery.The multivariate Logistic regression analysis showed that pre-operation e GFR(HR = 0.52,95% CI 0.46-0.77;P = 0.043),the amount of red cell infusion during the surgery(HR = 1.05,95% CI 1.01-1.26;P = 0.046),and the use of vasoactive agent during RRT(HR =1.26,95% CI 1.09-1.56;P = 0.037)were the independent risk factors of no renal recovery.Conclusion: 1.The prediction model may serve as a simple,accurate tool for predicting in-hospital RRT failure in patients with AKI following cardiac surgery.2.Most likely,for post-cardiac surgery patients had AKI and needed RRT,lower pre-operation e GFR,more red cell infusion during the operation,and the use of vasoactive agents during RRT may suggest lower possibility of renal recovery. |
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