Factors Associated With High-sensitivity C-reactive Protein And Acute Kidney Injury After Off Pump Coronary Artery Bypass Grafting In Patients With Coronary Heart Disease

BackgroundSince the reform and opening up in the last century,people’s quality of life has been greatly improved,and the way of life of the people has undergone tremendous changes.However,society is facing an increasingly serious problem of population aging.The incidence of cardiovascular events is increasing year by year.Cardiovascular diseases can be roughly divided into congenital heart disease and acquired heart disease.Among them,coronary atherosclerotic heart disease is acquired heart disease,and its incidence rate is also rising,and it is younger every year.China has a large population base and a high incidence of coronary atherosclerotic heart disease,so the treatment of the coronary atherosclerotic heart disease has always been an important topic for cardiovascular doctors.At this stage,the treatment can be roughly divided into two categories,conservative treatment of drugs and surgical treatment.Drug treatment is antiplatelet drugs,statins,vasodilator drugs,inhibition of myocardial remodeling drugs,etc.Surgical treatment can be divided into medical interventional therapy,surgical treatment,and one-stop hybrid surgery.The coronary artery bypass grafting is a common method of treating coronary atherosclerotic heart disease.It’s a thoracotomy.It is divided into on-pump coronary artery bypass grafting and off-pump coronary artery bypass grafting.The operation is very risky,with many complications,and the operative mortality rate is between 1% and 3%.Acute kidney injury is one kind of complication after coronary artery bypass grafting,and a common one,its incidence is about 30%.But only 30% of the patients were diagnosed and treated after surgery.Acute kidney injury significantly increases the length of hospital stay,increases the financial burden,and affects the patient’s prognosis,and even increases the patient’s mortality.As an inflammatory factor,hs-CRP has been found to play an important role in influencing renal function in recent years,but there has been not much reports on the correlation between hs-CRP and acute renal injury after coronary artery bypass grafting.ObjectiveThrough collecting the clinical data of patients with coronary atherosclerotic heart disease undergoing off pump coronary artery bypass grafting,to analyzing the risk factors of acute kidney injury after off pump coronary artery bypass grafting.And by analyzing whether acute kidney injury occurred in patients with coronary atherosclerotic heart disease undergoing off pump coronary artery bypass grafting,to look for the positive clinical indexes,it may provide clinicians with active prevention for patients who may have acute kidney injury after the operation.To reduce the complications of kidney injury in patients.Methods1、objectFrom August 2016 to June 2018,102 patients with CHD were treated by off pump coronary artery bypass grafting in the first affiliated Hospital of Zhengzhou University.2、Group:From August 2016 to June 2018,102 patients with coronary heart disease were treated in the first affiliated Hospital of Zhengzhou University and received off pump coronary artery bypass grafting.The patients were divided into acute kidney injury group(32 cases)and non-acute renal injury group(70 cases)according to whether or not acute renal injury occurred after operation.The patients were divided into low expression group(51 cases)and high expression group(51 cases)according to the median level of serum high sensitive C-reactive protein.3、methodStatistical analysis was used to analyze the differences and correlation of the different groups’ clinical data in the 102 patients.And exploring the risk factors for postoperative AKI,p<0.05 was considered significant statistically.ResultsComparing with the hs-CRP lower expression group,the higher expression group has a higher perioperative serum creatinine,white cell counts,the length of hospitalization and ICU stay,lower ejection fraction,and more AKI incidence,(all P<0.05).Comparing with the non-AKI group,AKI group has a higher levels of serum hs-CRP,serum creatinine,ejection fraction and the length of hospitalization and ICU stay,lower ejection fraction.The difference was statistically significant(all p < 0.05).Preoperative hs-CRP levels,serum creatinine levels,and the ejection fraction were the independent risk factors of postoperative AKI.Conclusion1、In patients with coronary heart disease who underwent off pump coronary artery bypass grafting(OP-CABG),the perioperative serum creatinine,hs-CRP,ejection fraction is associated with whether or not AKI occurs after surgery.2、Serum creatinine,hs-CRP and the ejection fraction are the independent risk factors of postoperative AKI in patients with coronary heart disease.3、The high expression of hs-CRP before operation and post-operation AKI could increase the length of stay in ICU and the length of hospitalization.Therefore,for the patients with high serum hs-CRP levels before operation,we suggest to give some renal protection to reduce the incidence of acute kidney injury after operation.