评估肾小球滤过率变化对老年瓣膜置换术患者的预后价值。

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics Pub Date : 2024-12-04 DOI:10.1016/j.archger.2024.105719

Le Yang , Zhang-jun Wu , Han Weng , Di Wu , Jun-quan Lu , Sheng-long Chen

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引用次数: 0

摘要

背景：虽然估计肾小球滤过率（eGFR）是评估肾功能的常用指标，但其在接受瓣膜置换术的老年患者中的预后价值仍不确定。方法：回顾性纳入2010年1月至2019年4月在广东省人民医院行瓣膜置换术的4531例老年患者（年龄≥60岁）。根据术后早期与术前估计肾小球滤过率（eGFR）的差异将患者分为ΔeGFR≤0、0 < ΔeGFR≤25、25 < ΔeGFR < 50和ΔeGFR≥50四组。使用单变量和多变量分析检查术后eGFR变化与住院和一年内死亡率之间的关系。Kaplan-Meier曲线用于说明累积危险率。结果：住院期间死亡204例（4.5%），1年内死亡344例（7.59%）。我们的分析显示ΔeGFR≤0和ΔeGFR≥50患者的临床结果有显著差异。ΔeGFR≥50的患者术后透析（P < 0.001）、急性心力衰竭（P = 0.037）和住院死亡率（P < 0.001）较高。累积生存曲线显示ΔeGFR≥50患者的一年死亡率明显高于其他三组（p < 0.0001）。多变量分析显示ΔeGFR≥50与住院死亡率（OR = 2.939, P < 0.001）和一年全因死亡率（HR = 2.567, P < 0.001）均有显著相关性。结论：我们的研究确定ΔeGFR≥50是临床事件和住院死亡率的独立危险因素。

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The prognostic value of estimated glomerular filtration rate change in elderly patients undergoing valvular replacement surgery

Background

While the estimated glomerular filtration rate (eGFR) is a common metric for assessing kidney function, its prognostic value in elderly patients undergoing valvular replacement surgery remains uncertain.

Methods

A total of 4531 elderly patients (aged ≥ 60 years) who underwent valvular replacement surgery at Guangdong Provincial People's Hospital in China were retrospectively included in the study, covering the period from January 2010 to April 2019. The patients were divided into four groups based on the difference between early postoperative and preoperative estimated glomerular filtration rates (eGFR): ΔeGFR ≤ 0, 0 < ΔeGFR ≤ 25, 25 < ΔeGFR < 50, and ΔeGFR ≥ 50. The association between postoperative eGFR changes and both in-hospital and one-year mortality was examined using univariate and multivariate analyses. Kaplan-Meier curves were used to illustrate cumulative hazard rates.

Result

Overall, 204 patients (4.5 %) died during their hospital stay, and 344 patients (7.59 %) patients died within one year. Our analysis revealed significant differences in clinical outcomes between patients with ΔeGFR ≤ 0 and those with ΔeGFR ≥ 50. Patients with ΔeGFR ≥ 50 had higher rates of postoperative dialysis (P < 0.001), acute heart failure (P = 0.037), and in-hospital mortality (P < 0.001). Cumulative survival curves showed a markedly higher one-year mortality rate among patients with ΔeGFR ≥ 50 compared to the other three groups (p < 0.0001). Multivariable analyses demonstrated a significant association between ΔeGFR ≥ 50 and both in-hospital mortality (OR = 2.939, P < 0.001) and one-year all-cause mortality (HR = 2.567, P < 0.001).

Conclusion

Our study identified ΔeGFR ≥ 50 as an independent risk factor for clinical events and in-hospital mortality.

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来源期刊

Archives of gerontology and geriatrics 医学-老年医学

CiteScore

7.30

自引率

5.00%

发文量

198

审稿时长

16 days

期刊介绍： Archives of Gerontology and Geriatrics provides a medium for the publication of papers from the fields of experimental gerontology and clinical and social geriatrics. The principal aim of the journal is to facilitate the exchange of information between specialists in these three fields of gerontological research. Experimental papers dealing with the basic mechanisms of aging at molecular, cellular, tissue or organ levels will be published. Clinical papers will be accepted if they provide sufficiently new information or are of fundamental importance for the knowledge of human aging. Purely descriptive clinical papers will be accepted only if the results permit further interpretation. Papers dealing with anti-aging pharmacological preparations in humans are welcome. Papers on the social aspects of geriatrics will be accepted if they are of general interest regarding the epidemiology of aging and the efficiency and working methods of the social organizations for the health care of the elderly.