1.重庆医科大学附属第一医院肝胆外科,重庆 400010
2.重庆医科大学附属第二医院急救部,重庆 400010
Received:13 June 2022,
Published:28 August 2022
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张舒,许珊,秦开秀,等.冠脉搭桥术后发生早期急性肾损伤的风险评估[J].重庆医科大学学报,2022,47(8):963-969.
Zhang Shu,Xu Shan,Qin Kaixiu,et al.Risk assessment of early acute kidney injury after coronary artery bypass grafting[J].Journal of Chongqing Medical University,2022,47(8):963-969.
张舒,许珊,秦开秀,等.冠脉搭桥术后发生早期急性肾损伤的风险评估[J].重庆医科大学学报,2022,47(8):963-969. DOI: 10.13406/j.cnki.cyxb.003085.
Zhang Shu,Xu Shan,Qin Kaixiu,et al.Risk assessment of early acute kidney injury after coronary artery bypass grafting[J].Journal of Chongqing Medical University,2022,47(8):963-969. DOI: 10.13406/j.cnki.cyxb.003085.
目的
2
研究血红蛋白-红细胞分布宽度比值(hemoglobin / red blood cell distribution width ratio,HRR)与冠脉搭桥手术(coronary artery bypass grafting,CABG)后急性肾损伤(acute kidney injury,AKI)发生风险的相关性。
方法
2
选择重症监护数据集(Medical Information Mart for Intensive Care Database,MIMIC)-Ⅳ中所有CABG术后患者作为研究对象,根据是否发生AKI分为2组。比较分析2组一般资料,并将有统计学差异的变量纳入logistic单因素回归分析,以单因素分析中
P
<
0.05的变量纳入多因素logistic回归分析。Logistic回归模型评估HRR对CABG术后AKI风险的预测价值。亚组分析采用层次回归模型。
结果
2
共5 623例患者纳入研究,AKI组4 342例,非AKI组1 281例。AKI组患者入院时HRR水平明显低于非AKI组(
P
<
0.001)。多因素回归模型显示HRR是预测CABG术后AKI风险的独立危险因子(
OR
=0.92,95%CI=0.88~0.96,
P
<
0.001)。Logistic回归模型发现,在模型Ⅲ中(调整潜在混杂因素),HRR水平降低仍然是CABG术后发生AKI的独立影响因素。亚组分析发现HRR与AKI发生的相关性在大多数协变量中相似。
结论
2
低HRR水平是CABG术后AKI发生风险的独立危险因素。
Objective
2
To investigate the association between the hemoglobin / red blood cell distribution width ratio(HRR)and early acute kidney injury(AKI)after coronary artery bypass grafting(CABG).
Methods
2
All patients were enrolled from the Medical Information Mart for Intensive Care Database(MIMIC)-Ⅳ. The patients were divided into 2 groups according to whether AKI occurred. The general data of the 2 groups were compared and analyzed,the variables with statistical difference were included in logistic univariate regression analysis,and variables with
P
<
0.05 were included in multivariate logistic regression analysis. Logistic regression model was used to evaluate the predictive value of HRR for AKI risk after CABG. Stratified regression model was used for subgroup analysis.
Results
2
A total of 5 623 patients were enrolled in the study,including 4 342 cases in the AKI group and 1 281 cases in the non-AKI group. The HRR level at admission in AKI group was significantly lower than that in non-AKI group(
P
<
0.001). Multivariate regression model showed that HRR was an independent risk factor for AKI after CABG(
OR
=0.92,95%CI=0.88-0.96,
P
<
0.001). Logistic regression model showed that in model Ⅲ(adjusting for potential confounders),low HRR level was still an independent influencing factor for AKI after CABG. Subgroup analysis found that the association between HRR and AKI was similar in most covariates.
Conclusion
2
Low HRR level is an independent risk factor for AKI after CABG.
Massoth C , Zarbock A , Meersch M . Acute kidney injury in cardiac surgery [J ] . Crit Care Clin , 2021 , 37 ( 2 ): 267 - 278 .
Hobson CE , Yavas S , Segal MS , et al . Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery [J ] . Circulation , 2009 , 119 ( 18 ): 2444 - 2453 .
Luo XY , Jiang L , Du B , et al . A comparison of different diagnostic criteria of acute kidney injury in critically ill patients [J ] . Crit Care , 2014 , 18 ( 4 ): R144 .
Perez-Valdivieso JR , Monedero P , Vives M , et al . Cardiac-surgery associated acute kidney injury requiring renal replacement therapy. A Spanish retrospective case-cohort study [J ] . BMC Nephrol , 2009 , 10 : 27 .
Oh TK , Song IA . Postoperative acute kidney injury requiring continuous renal replacement therapy and outcomes after coronary artery bypass grafting:a nationwide cohort study [J ] . J Cardiothorac Surg , 2021 , 16 ( 1 ): 315 .
Mehta RH , Hafley GE , Gibson CM , et al . Influence of preoperative renal dysfunction on one-year bypass graft patency and two-year outcomes in patients undergoing coronary artery bypass surgery [J ] . J Thorac Cardiovasc Surg , 2008 , 136 ( 5 ): 1149 - 1155 .
Brown JR , Cochran RP , MacKenzie TA , et al . Long-term survival after cardiac surgery is predicted by estimated glomerular filtration rate [J ] . Ann Thorac Surg , 2008 , 86 ( 1 ): 4 - 11 .
Zhai Z , Gao JL , Zhu ZY , et al . The ratio of the hemoglobin to red cell distribution width combined with the ratio of platelets to lymphocytes can predict the survival of patients with gastric cancer liver metastasis [J ] . Biomed Res Int , 2021 , 2021 : 8729869 .
Qu JL , Zhou T , Xue MX , et al . Correlation analysis of hemoglobin-to-red blood cell distribution width ratio and frailty in elderly patients with coronary heart disease [J ] . Front Cardiovasc Med , 2021 , 8 : 728800 .
Qin ZA , Liao NH , Lu XL , et al . Relationship between the hemoglobin-to-red cell distribution width ratio and all-cause mortality in ischemic stroke patients with atrial fibrillation:an analysis from the MIMIC-IV database [J ] . Neuropsychiatr Dis Treat , 2022 , 18 : 341 - 354 .
Xiu WJ , Zheng YY , Wu TT , et al . Hemoglobin-to-red-cell distribution width ratio is a novel predictor of long-term patient outcomes after percutaneous coronary intervention:a retrospective cohort study [J ] . Front Cardiovasc Med , 2022 , 9 : 726025 .
Rahamim E , Zwas DR , Keren A , et al . The ratio of hemoglobin to red cell distribution width:a strong predictor of clinical outcome in patients with heart failure [J ] . J Clin Med , 2022 , 11 ( 3 ): 886 .
Johnson ABL , Pollard T , Horng S , et al . MIMIC-IV(version 0 . 4 ). PhysioNet 2020.[Online ] Available: https://www.physionet.org/ https://www.physionet.org/ .
许 珊 , 秦开秀 . 入院时血清阴离子间隙与重症患者病死率的相关性 [J ] . 中国急救医学 , 2021 , 41 ( 11 ): 983 - 988 .
Xu S , Qin KX . The relationship between the serum anion gap level and the mortality in critically ill patients [J ] . Chin J Crit Care Med , 2021 , 41 ( 11 ): 983 - 988 .
Zhou SY , Zeng ZH , Wei HX , et al . Early combination of albumin with crystalloids administration might be beneficial for the survival of septic patients:a retrospective analysis from MIMIC-IV database [J ] . Ann Intensive Care , 2021 , 11 ( 1 ): 42 .
Ulrich H , Behrend P , Wiedekopf J , et al . Hands on the medical informatics initiative core data set - lessons learned from converting the MIMIC-IV [J ] . Stud Health Technol Inform , 2021 , 283 : 119 - 126 .
Khwaja A . KDIGO clinical practice guidelines for acute kidney injury [J ] . Nephron Clin Pract , 2012 , 120 ( 4 ): c179 - c184 .
Wu FF , Yang SX , Tang XH , et al . Prognostic value of baseline hemoglobin-to-red blood cell distribution width ratio in small cell lung cancer:a retrospective analysis [J ] . Thorac Cancer , 2020 , 11 ( 4 ): 888 - 897 .
Tham T , Olson C , Wotman M , et al . Evaluation of the prognostic utility of the hemoglobin-to-red cell distribution width ratio in head and neck cancer [J ] . Eur Arch Oto Rhino Laryngol , 2018 , 275 ( 11 ): 2869 - 2878 .
Ostermann M , Bellomo R , Burdmann EA , et al . Controversies in acute kidney injury:conclusions from a Kidney Disease:improving Global Outcomes(KDIGO)Conference [J ] . Kidney Int , 2020 , 98 ( 2 ): 294 - 309 .
刘平丽 . 以KDIGO评分系统评估重症医学科病房患者急性肾损伤的发病率、预后及其死亡相关危险因素 [D ] . 济南 : 山东大学 , 2016 .
Liu PL . Scoring system to assess the incidence of acute kidney injury in patients with severe medical ward rate,prognosis and death risk factors associated with KDIGO [D ] . Jinan : Shandong University , 2016 .
Hoste EAJ , Bagshaw SM , Bellomo R , et al . Epidemiology of acute kidney injury in critically ill patients:the multinational AKI-EPI study [J ] . Intensive Care Med , 2015 , 41 ( 8 ): 1411 - 1423 .
de Almeida DC , Franco MDCP , dos Santos DRP , et al . Acute kidney injury:incidence,risk factors,and outcomes in severe COVID-19 patients [J ] . PLoS One , 2021 , 16 ( 5 ): e0251048 .
Demirjian S , Bashour CA , Shaw A , et al . Predictive accuracy of a perioperative laboratory test-based prediction model for moderate to severe acute kidney injury after cardiac surgery [J ] . JAMA , 2022 , 327 ( 10 ): 956 - 964 .
Ostermann M , Lumlertgul N , Wilson FP . Predictive models for acute kidney injury following cardiac surgery:the importance of accurate and actionable prediction [J ] . JAMA , 2022 , 327 ( 10 ): 927 - 929 .
Jiang HQ , Jiang W , Tan LP , et al . The predictive value of pretreatment haemoglobin-to-red cell distribution width ratio for overall survival of patients with advanced non-small cell lung cancer:a propensity score matching analysis [J ] . J Int Med Res , 2021 , 49 ( 4 ): 3000605211004
Yilmaz A , Yilmaz H , Tekin SB , et al . The prognostic significance of hemoglobin-to-red cell distribution width ratio in muscle-invasive bladder cancer [J ] . Biomark Med , 2020 , 14 ( 9 ): 727 - 738 .
Yilmaz A , Mirili C , Tekin SB , et al . The ratio of hemoglobin to red cell distribution width predicts survival in patients with gastric cancer treated by neoadjuvant FLOT:a retrospective study [J ] . Ir J Med Sci , 2020 , 189 ( 1 ): 91 - 102 .
Yu Z , Zhang T , Shen JJ . Low hemoglobin-to-red cell distribution width ratio is associated with mortality in patients with HBV-related decompensated cirrhosis [J ] . Biomed Res Int , 2022 , 2022 : 5754790 .
Perek B , Maison D , Budnick S , et al . Preoperative blood morphology and incidence of acute kidney injury after on-pump coronary artery bypass grafting-a single-center preliminary report [J ] . Kardiochir Torakochirurgia Pol , 2018 , 15 ( 1 ): 18 - 22 .
Hu J , Rezoagli E , Zadek F , et al . Free hemoglobin ratio as a novel biomarker of acute kidney injury after on-pump cardiac surgery:secondary analysis of a randomized controlled trial [J ] . Anesth Analg , 2021 , 132 ( 6 ): 1548 - 1558 .
Shaver CM , Paul MG , Putz ND , et al . Cell-free hemoglobin augments acute kidney injury during experimental sepsis [J ] . Am J Physiol Renal Physiol , 2019 , 317 ( 4 ): F922 - F929 .
Brezis M , Rosen S . Hypoxia of the renal medulla:its implications for disease [J ] . N Engl J Med , 1995 , 332 ( 10 ): 647 - 655 .
Lombardi Y , Ridel C , Touzot M . Anaemia and acute kidney injury:the tip of the iceberg? [J ] . Clin Kidney J , 2020 , 14 ( 2 ): 471 - 473 .
Wang RR , He M , Ou XF , et al . The predictive value of RDW in AKI and mortality in patients with traumatic brain injury [J ] . J Clin Lab Anal , 2020 , 34 ( 9 ): e23373 .
Nanjarapalle S , Samantaray A , Vishnubhotla S . Red cell distribution width as a severity marker on the outcome of patients with acute kidney injury on renal replacement therapy [J ] . Indian J Crit Care Med , 2020 , 24 ( 2 ): 95 - 98 .
Xanthopoulos A , Tryposkiadis K , Dimos A , et al . Red blood cell distribution width in elderly hospitalized patients with cardiovascular disease [J ] . World J Cardiol , 2021 , 13 ( 9 ): 503 - 513 .
Perlstein TS , Weuve J , Pfeffer MA , et al . Red blood cell distribution width and mortality risk in a community-based prospective cohort [J ] . Arch Intern Med , 2009 , 169 ( 6 ): 588 - 594 .
Salvagno GL , Sanchis-Gomar F , Picanza A , et al . Red blood cell distribution width:a simple parameter with multiple clinical applications [J ] . Crit Rev Clin Lab Sci , 2015 , 52 ( 2 ): 86 - 105 .
Singbartl K , Kellum JA . AKI in the ICU:definition,epidemiology,risk stratification,and outcomes [J ] . Kidney Int , 2012 , 81 ( 9 ): 819 - 825 .
Oprea AD , del Rio JM , Cooter M , et al . Pre- and postoperative anemia,acute kidney injury,and mortality after coronary artery bypass grafting surgery:a retrospective observational study [J ] . Can J Anesth Can D'anesthésie , 2018 , 65 ( 1 ): 46 - 59 .
Zafrani L , Ergin B , Kapucu A , et al . Blood transfusion improves renal oxygenation and renal function in sepsis-induced acute kidney injury in rats [J ] . Crit Care , 2016 , 20 ( 1 ): 406 .
Semba RD , Patel KV , Ferrucci L , et al . Serum antioxidants and inflammation predict red cell distribution width in older women:the Women's Health and Aging Study I [J ] . Clin Nutr , 2010 , 29 ( 5 ): 600 - 604 .
den Elzen WPJ , Gussekloo J . Anaemia in older persons [J ] . Neth J Med , 2011 , 69 ( 6 ): 260 - 267 .
Patel KV , Semba RD , Ferrucci L , et al . Red cell distribution width and mortality in older adults:a Meta-analysis [J ] . J Gerontol A Biol Sci Med Sci , 2010 , 65 ( 3 ): 258 - 265 .
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