Research On Risk Scores And Predicting Factors Of Cardiac Surgery Postoperative Acute Kidney Injury

OBJECTIVE: 1.To predict the preoperative risk score of acute kidney injury(AKI)by comparing the incidence of cardiac surgery-associated AKI(CSA-AKI)with three different clinical risk scores in order to predict the incidence of acute kidney injury(AKI)in our medical center.2.Make a comparison by combining the cardiac function and renal function clinical indicators of perioperative changes in cardiac surgery after AKI and non-AKI cases to confirm the combined heart and kidney function indicators be used to predict cardiac postoperative AKI,and to provide an evidence for clinical conditions.3.Combined with preoperative predictive score and perioperative indicators,we can contribute to the future clinical conditions to better predict the possibly postoperative AKI happening,and timely treatment for it.METHODS:1.Retrospective selection of a total of 303 cases from May 2013 to December 2015 admitted to hospital,with no-pump coronary artery bypass grafting(OPCAB)surgical procedures.By defining acute kidney injury diagnosis using the international common AKI diagnostic criteria KDIGO standard,the patients were divided into two groups: AKI group(47 cases)and non-AKI group(256 cases).The STS,Euro SCORE and Euro SCORE Ⅱ risk scores were compared between the two groups.And preoperative,intraoperative and postoperative clinical features,indicators,complications and mortality were calculated and analyzed.2.This study was a single center,prospective,selected from May 2016to January 2017 in Shanghai Renji Hospital,a total of 444 cases of cardiac surgery.The perioperative clinical parameters were collected and the preoperative Euro SCORE Ⅱ risk score was calculated.Serum B-type natriuretic peptide(BNP)and Cystatin C(Cys C)were examined twice 24 h before and 24 h after operation to obtain BNP and Cys C perioperative changes(ΔBNP,ΔCys C).To evaluate the risk factors of postoperative AKI by perioperative clinical indicators,and to evaluate the effect of perioperative changes of BNP and Cys C on postoperative AKI.RESULTS: 1.The preoperative Euro SCORE Ⅱ score(%)in the AKI group was significantly higher than that in the non-AKI group [(5.37±4.37)vs(3.17±3.09),P = 0.0003].There was no significant difference in STS and Euro SCORE scores between the two groups.Statistically significance is observed in body mass index(BMI)(P=0.07),left ventricular ejection fraction(LVEF)(P=0.007),preoperative serum creatinine(P=0.001),intraaortic balloon counterpulsation pump(IABP)insertion(P<0.01),the rate of myocardial infarction(7.69% vs 0.36%,P<0.01),the infection rate(46.15% vs 10.91%,P<0.001)and the mortality rate(6.15% vs 0.36%,P<0.001).2.The levels of ΔBNP(479.282±744.289 vs 235.912±283.593,P<0.001),ΔCys C(0.399±0.478 vs-0.082±0.172,P<0.001)were significantly higher in the AKI group and non-AKI group Statistical differences.(0.691),preoperative Cys C(0.666)and BNP(0.641)were significantly higher than those in the control group(P <0.05).The results showed that the odds ratio of ΔBNP combined with ΔCys C curve was 0.901,which was superior to Euro SCORE Ⅱ risk score(0.691),preoperative Cys C(0.666)and BNP value(0.641).CONCLUSIONS:1.The preoperative Euro SCORE Ⅱ risk score can be used to predict theincidence of AKI after cardiac surgery.The Euro SCORE Ⅱ score predicts a better postoperative AKI than the STS and Euro SCORE scores.2.The changes of perioperative value of BNP and Cys C were positively correlated with the occurrence of postoperative AKI.Combination of perioperative changes in BNP and Cys C is effective in predicting acute kidney injury associated with cardiac surgery.SIGNIFICANCE: This study examines the perioperative risk factors for cardiac surgery-associated acute kidney injury and evaluates its predictive efficacy in acute kidney injury using the Euro SCORE Ⅱ risk score and combines cardiac function and renal function indicators for the first time.This study brings in new methods and procedures on evaluation of cardiac surgery-associated acute kidney injury and prediction of proposed in the clinical diagnosis and treatment of guiding significance.