溶血指数和体外循环时间作为心脏手术相关急性肾损伤的预测因子：一项观察性队列研究。

IF 2.1 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia Pub Date : 2025-07-28 DOI:10.1053/j.jvca.2025.07.038

Michela Di Pierro MD , Matteo Pozzi MD , Marta Frazzei MD , Benedetta Fumagalli MD , Marco Casati MD , Silvia Mariani MD , Giovanni Marchetto MD, PhD , Giuseppe Foti MD , Emanuele Rezoagli MD, PhD , Marco Giani MD

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引用次数: 0

摘要

目的：急性肾损伤（AKI）是心脏手术常见且严重的并发症，通常与体外循环（CPB）的使用和持续时间有关。溶血指数（HI）已被提议作为溶血的替代标志物和心脏手术相关AKI （CS-AKI）的潜在预测因子。本研究旨在评估CPB时间和HI与CS-AKI发病之间的关系。设计：观察性队列研究；前瞻性收集资料的回顾性分析。环境：单一中心，意大利大学三级护理医院。参与者：2019年至2023年期间心脏手术后入住心胸重症监护病房（ICU）的患者。干预措施：HI在ICU入院时测量。CS-AKI及其严重程度的定义采用肾脏疾病：改善全球预后肌酐为基础的标准。采用logistic回归分析评估HI、CPB持续时间和CS-AKI之间的关系，并根据克利夫兰临床评分进行调整。测量和主要结果：共纳入1195例患者。中位年龄为70岁（四分位数范围[IQR] 62-75），女性310例（26%）。CPB中位持续时间为110分钟（IQR 80-140）， ICU入院时的中位HI为25分钟（IQR 15-42）。HI与CPB持续时间呈中度相关（r = 0.367, p < 0.001）。CS-AKI发生103例（9%）。在多变量分析中，HI和CPB时间与CS-AKI均独立相关（HI每增加10个单位的比值比为1.52,95%可信区间为1.04-2.18,p = 0.027； CPB每小时的比值比为1.32,95%可信区间为1.08-1.63,p < 0.001）。结论：HI和CPB时间与CS-AKI独立相关。将这些参数纳入CS-AKI预测模型的效用值得进一步评估。

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Hemolysis Index and Cardiopulmonary Bypass Time as Predictors of Cardiac Surgery-associated Acute Kidney Injury: An Observational Cohort Study

Objectives

Acute kidney injury (AKI) is a common and serious complication of cardiac surgery, often linked to the use and duration of cardiopulmonary bypass (CPB). The Hemolysis Index (HI) has been proposed as a surrogate marker of hemolysis and a potential predictor of cardiac surgery-associated AKI (CS-AKI). This study was designed to evaluate the associations between CPB time and HI with the onset of CS-AKI.

Design

An observational cohort study; retrospective analysis of prospectively collected data.

Setting

A single-center, Italian university tertiary care hospital.

Participants

Patients admitted to the cardiothoracic intensive care unit (ICU) following cardiac surgery between 2019 and 2023.

Interventions

HI was measured at ICU admission. CS-AKI and its severity were defined using the Kidney Disease: Improving Global Outcomes creatinine-based criteria. Associations between HI, CPB duration, and CS-AKI were assessed using logistic regression analyses, adjusting for the Cleveland Clinic Score.

Measurements and Main Results

A total of 1,195 patients were included in the analysis. Median age was 70 years (interquartile range [IQR] 62-75), and 310 patients (26%) were female. Median CPB duration was 110 minutes (IQR 80-140), and median HI at ICU admission was 25 (IQR 15-42). HI showed a moderate correlation with CPB duration (r = 0.367, p < 0.001). CS-AKI occurred in 103 patients (9%). In multivariable analysis, both HI and CPB time were independently associated with CS-AKI (odds ratio per 10-unit increase in HI 1.52, 95% confidence interval 1.04-2.18, p = 0.027; odds ratio per hour of CPB 1.32, 95% confidence interval 1.08-1.63, p < 0.001).

Conclusions

HI and CPB time were independently associated with CS-AKI. The utility of incorporating these parameters into CS-AKI predictive models warrants further evaluation.

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来源期刊

Journal of cardiothoracic and vascular anesthesia 医学-呼吸系统

CiteScore

4.80

自引率

17.90%

发文量

606

审稿时长

37 days

期刊介绍： The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.