Risk Factors And Prediction Model Of Acute Kidney Injury During Perioperative Period Of Coronary Artery Bypass Grafting

Background and purposeCoronary artery bypass grafting(CABG)is an important method for the treatment of coronary atherosclerotic heart disease,especially the three vessel disease.However,the perioperative complications seriously affected the effect of surgery.Acute Kidney Injury(AKI)is a serious complication of CABG,Which increased perioperative treatment difficulty.When patients have a renal failure,the mortality rate will be greatly increased.Early prevention,early diagnosis is very important to improve the prognosis of patients.In this study,134 cases of CABG were analyzed by statistical analysis to explore the risk factors of AKI in perioperative period of CABG,and to establish the prediction model of AKI in perioperative period.Method134 patients with coronary artery bypass grafting in our hospital from October 2011 to October 2016 were selected.The general situation of patients were collected: gender,age and weight,history of smoking.Preoperative indexes: serum creatinine,N terminal B type natriuretic peptide and left ventricular ejection fraction;Whether there is a basic disease: dyslipidemia,hypertension,type 2 diabetes,cerebrovascular accident,etc;Operation: cardiopulmonary bypass time,aortic clamping time;Postoperative conditions: glomerular filtration rate,ventilation time,monitoring time,postoperative hospital stay.The patients were divided into two groups: AKI group and control group according to the AKI.SPSS21.0 was used to analyze the data,and the risk factors were screened out from various risk factors,and then the multivariate Logistic regression analysis was used to establish the regression model.Finally,the performance curves of the subjects were used to test the effectiveness of the regression model.ResultUnivariate analysis: Compared with the control group,there was a significant difference between the AKI group and the control group in body weight,hypertension,cerebrovascular accident history,preoperative SCr,NT-pro BNP,cardiopulmonary bypass time,aortic time,postoperative GFR,postoperative ventilation time,postoperative ICU stay time and other factors(P < 0.05).Logistic regression analysis was performed on the statistically significant variables in univariate analysis.The preoperative SCr,postoperative GFR,and postoperative ventilation time were entered into the Logistic regression equation.Prediction model is established as follows:(?)Describe the ROC curve to test the Logistic equation:the area under the ROC curve=0.958±0.024,the 95% confidence interval was 0.911 ~ 1,and the cut-off point was 0.5.The sensitivity of Logistic equation to predict CABG combined with AKI was 94.6%,and the specificity of Logistic equation for predicting CABG combined with AKI was 94.6%.ConclusionAKI after CABG is associated with multiple risk factors,Including: weight,history of hypertension,cerebrovascular accident history,preoperative SCr,NT-pro BNP,cardiopulmonary bypass time,aortic occlusion time,postoperative GFR,postoperative ventilation time,postoperative stay time,etc.The increase of preoperative SCr,the decrease of postoperative GFR,and the prolongation of postoperative ventilation time were independent risk factors for concurrent AKI.The established Logistic regression model has high sensitivity and specificity,and also has a certain clinical value in predicting CABG AKI in perioperative period.