A Retrospective Study Of Risk Factors For Acute Kidney Injury Associated With Cardiac Surgery

Part one Incidence and influencing factors of cardiac surgery-associated acute kidney injury based on the KDIGO criteria:A retrospective cohort studyObjective:To evaluate the incidence,risk or protective factors of acute kidney injury(AKI)in patients undergoing cardiac surgery.Methods A total of 2575 patients who underwent cardiac surgery with cardiopulmonary bypass(CPB)between January 2008 and December 2012 in our center were screened for retrospective analysis Univariate and multiple logistic regression models were employed for identifying the association between the development of AKI and risk factors.Multiple Cox-proportional hazards modeling was used to evaluate the effects of AKI on the mortality of ICU and hospital length of stay(LOS).Kaplan-Meir Survival Analysis was used to evaluate the influence of different KDIGO stages on the 30-day mortality.Results Of 2575 patients,931(36%)occurred AKI.A number of 30(1.2%)patients underwent renal replacement therapy.The overall in-hospital mortality rate was 1.5%(38 of 2575).Using multivariate analysis,mechanical ventilation duration(P<0.001),CPB duration of>110min(P = 0.009),erythrocytes transfusion(P<0.001)and postoperative body temperature greater than 38? within 3 days(P = 0.032)were found to be independent risk factors for CSA-AKI,while ulinastatin administration was related to lower incidence of CSA-AKI(P = 0.006).CSA-AKI was significantly associated with an increased in-hospital mortality(P = 0.016),especially in patients requiring RRT(P<0.001).AKI(KDIGO stage 2-3)was related to increased 30-day mortality(P<0.001).Conclusions Our study revealed that mechanical ventilation duration,erythrocytes transfusion and postoperative fever above 38°C within 3 days were independent risk factors for CSA-AKI.Ulinastatin administration correlated to alower incidence of CSA-AKI.Part two Propensity-matched analysis of the renoprotective role of ulinastatin use in patients undergoing cardiac surgery with extracorporeal circulationObjective To investigate whether ulinastatin use during cardiac surgery with cardiopulmonary bypass(CPB)is associated with a lower incidence of cardiac surgery associated acute kidney injury(CSA-AKI).Methods Data from 2072 consecutive adult patients undergoing cardiac surgery with CPB from January 2008 to December 2012 in hospital records was retrospectively collected.Propensity score matched study was employed to compare the outcomes between the ulinastatin treatment patients and non-ulinastatin treatment patients.Logistic regression was used to determine the relationship between ulinastin use and the occurrence of AKI.Results Propensity score matched cohort analysis showed that AKI and the need for renal replacement therapy(RRT)had a higher occurrence rate in the control group(40.83%vs.30.32%,P=0.002;2.44%vs.0.49%,P=0.02,respectively)than that in ulinastatin group.No significant differences of mortality,length of ICU stay and length of hospital stay between the ulinastatin group and control group were found(P>0.05).Using logistic regression model,patients who received ulinastatin were found to have an decrease risk of developing AKI after cardiac surgery(OR 0.710,95%CI 0.558-0.903,P=0.005).Conclusions This study demonstrated that ulinastatin use palyed a renoproteve role in the development of AKI after cardiac surgery,suggesting that patients undergoing cardiac surgery with CPB may benefit from the use of ulinastatin.