目的 探讨术前血清尿酸/白蛋白比值（serum uric acid/albumin ratio，sUAR）对心脏瓣膜术后急性肾损伤（acute kidney injury，AKI）的预测价值。 方法 采用回顾性分析方法，收集2021年1月至2021年12月于河南省人民医院心脏中心在体外循环下行心脏瓣膜术的成年患者的临床资料，并计算sUAR。根据术后7 d内是否发生AKI将患者分为AKI组和非AKI组，比较两组之间临床资料的差异。采用多因素Logistic回归模型分析心脏瓣膜术后发生AKI的独立相关因素。采用受试者工作特征曲线（receiver operating characteristic curve，ROC曲线）评价相关指标的预测效能。 结果 共422例行心脏瓣膜术患者入选本研究，其中女性194例（46.0%），高血压141例（33.4%），心房颤动172例（40.8%），年龄57（50，65）岁，sUAR 8.13（6.57，9.54）μmol/g，血红蛋白135（125，145）g/L；AKI组142例，非AKI组280例；心脏瓣膜术后AKI的发生率为33.6%。AKI组年龄、心房颤动比例、基线血肌酐、N端脑利钠肽前体、血尿素、血尿酸、血糖、sUAR均高于非AKI组（均P<0.05），估算肾小球滤过率、淋巴细胞计数、血红蛋白、血清白蛋白均低于非AKI组（均P<0.05）；AKI组患者中位体外循环时间较非AKI组患者略长但差异无统计学意义［159（125，192）min比151（122，193）min，Z=-0.797，P=0.426］，其他指标两组间差异均无统计学意义。多因素Logistic回归分析结果显示，sUAR（OR=1.467，95% CI 1.308～1.645，P<0.001）、年龄（OR=1.045，95% CI 1.020～1.072，P<0.001）、心房颤动（OR=2.520，95% CI 1.580～4.020，P<0.001）、血红蛋白（OR=0.984，95% CI 0.971～0.997，P=0.015）是心脏瓣膜术后发生AKI的独立相关因素。ROC曲线分析结果显示sUAR预测心脏瓣膜术后发生AKI的曲线下面积为0.710（95% CI 0.659～0.760，P<0.001），截断值为7.28 μmol/g，敏感度为85.2%，特异度为45.0%。sUAR联合年龄、血红蛋白、心房颤动预测心脏瓣膜术后发生AKI的曲线下面积为0.780（95%CI 0.734～0.825，P<0.001），敏感度为72.5%，特异度为71.8%。 结论 术前sUAR高是体外循环下心脏瓣膜术后发生AKI的独立危险因素，sUAR对术后发生AKI具有一定预测价值。 Objective To investigate the predictive value of serum uric acid/albumin ratio (sUAR) for acute kidney injury (AKI) after cardiac valve surgery. Methods The clinical data of adult patients undergoing cardiac valve surgery under cardiopulmonary bypass from January 2021 to December 2021 from the Heart Center of Henan Provincial People's Hospital were collected retrospectively, and the sUAR was calculated. All patients were divided into AKI group and non-AKI group according to whether AKI occurred within 7 days after cardiac valve surgery, and the differences of clinical data between the two groups were compared. Multivariate logistic regression model was used to analyze the independent correlation factors of AKI after cardiac valve surgery. The receiver operating characteristic (ROC) curve was used to evaluate the performance of relevant indicators. Results A total of 422 patients were enrolled, including 194 females (46.0%), 141 hypertension patients (33.4%) and 172 atrial fibrillation patients (40.8%). They were 57 (50, 65) years old. Their sUAR was 8.13 (6.57, 9.54) μmol/g, and hemoglobin was 135 (125, 145) g/L. There were 142 cases in AKI group and 280 cases in non-AKI group, and the incidence of AKI after cardiac valve surgery was 33.6%. Age, atrial fibrillation rate, baseline serum creatinine, N terminal pro B type natriuretic peptide, serum urea,serum uric acid, blood glucose and sUAR were higher in the AKI group than those in the non-AKI group (all P<0.05), and estimated glomerular filtration rate, lymphocyte count,hemoglobin and serum albumin were lower in the AKI group than those in the non-AKI group (allP<0.05). The median cardiopulmonary bypass time of patients in the AKI group was slightly longer than that in the non-AKI group, but the difference was not statistically significant [159 (125, 192) minvs. 151 (122, 193) min, Z=-0.797, P=0.426], and there were no statistically significant differences in other indicators between the two groups. The results of multivariate logistic regression analysis showed that sUAR (OR=1.467, 95% CI 1.308-1.645, P<0.001), age (OR=1.045, 95% CI 1.020-1.072, P<0.001), atrial fibrillation (OR=2.520, 95% CI 1.580-4.020, P<0.001), hemoglobin (OR=0.984, 95% CI 0.971-0.997, P=0.015) were the independent correlation factors. ROC curve analysis showed that the area under the curve (AUC) of sUAR predicting AKI after cardiac valve surgery was 0.710 (95% CI 0.659-0.760, P<0.001) with a sensitivity of 85.2% and specificity of 45.0% for the sUAR cut-off point of 7.28 μmol/g. TheAUC for the diagnosis of AKI after cardiac valve surgery was 0.780 (95% CI 0.734-0.825,P<0.001) with a sensitivity of 72.5% and specificity of 71.8% for the combination of sUAR with age, hemoglobin and atrial fibrillation. Conclusions For patients undergoing cardiac valve surgery under cardiopulmonary bypass, preoperative high sUAR is an independent risk factor for postoperative AKI, and sUAR has a certain predictive value for postoperative AKI.
Abstract
Objective To investigate the predictive value of serum uric acid/albumin ratio (sUAR) for acute kidney injury (AKI) after cardiac valve surgery. Methods The clinical data of adult patients undergoing cardiac valve surgery under cardiopulmonary bypass from January 2021 to December 2021 from the Heart Center of Henan Provincial People's Hospital were collected retrospectively, and the sUAR was calculated. All patients were divided into AKI group and non-AKI group according to whether AKI occurred within 7 days after cardiac valve surgery, and the differences of clinical data between the two groups were compared. Multivariate logistic regression model was used to analyze the independent correlation factors of AKI after cardiac valve surgery. The receiver operating characteristic (ROC) curve was used to evaluate the performance of relevant indicators. Results A total of 422 patients were enrolled, including 194 females (46.0%), 141 hypertension patients (33.4%) and 172 atrial fibrillation patients (40.8%). They were 57 (50, 65) years old. Their sUAR was 8.13 (6.57, 9.54) μmol/g, and hemoglobin was 135 (125, 145) g/L. There were 142 cases in AKI group and 280 cases in non-AKI group, and the incidence of AKI after cardiac valve surgery was 33.6%. Age, atrial fibrillation rate, baseline serum creatinine, N terminal pro B type natriuretic peptide, serum urea,serum uric acid, blood glucose and sUAR were higher in the AKI group than those in the non-AKI group (all P<0.05), and estimated glomerular filtration rate, lymphocyte count,hemoglobin and serum albumin were lower in the AKI group than those in the non-AKI group (allP<0.05). The median cardiopulmonary bypass time of patients in the AKI group was slightly longer than that in the non-AKI group, but the difference was not statistically significant [159 (125, 192) minvs. 151 (122, 193) min, Z=-0.797, P=0.426], and there were no statistically significant differences in other indicators between the two groups. The results of multivariate logistic regression analysis showed that sUAR (OR=1.467, 95% CI 1.308-1.645, P<0.001), age (OR=1.045, 95% CI 1.020-1.072, P<0.001), atrial fibrillation (OR=2.520, 95% CI 1.580-4.020, P<0.001), hemoglobin (OR=0.984, 95% CI 0.971-0.997, P=0.015) were the independent correlation factors. ROC curve analysis showed that the area under the curve (AUC) of sUAR predicting AKI after cardiac valve surgery was 0.710 (95% CI 0.659-0.760, P<0.001) with a sensitivity of 85.2% and specificity of 45.0% for the sUAR cut-off point of 7.28 μmol/g. TheAUC for the diagnosis of AKI after cardiac valve surgery was 0.780 (95% CI 0.734-0.825,P<0.001) with a sensitivity of 72.5% and specificity of 71.8% for the combination of sUAR with age, hemoglobin and atrial fibrillation. Conclusions For patients undergoing cardiac valve surgery under cardiopulmonary bypass, preoperative high sUAR is an independent risk factor for postoperative AKI, and sUAR has a certain predictive value for postoperative AKI.
关键词
尿酸/血清白蛋白/心脏外科手术/急性肾损伤/心脏瓣膜术
Key words
Uric acid/Serum albumin/Cardiac surgical procedures/Acute kidney injury/Cardiac valve surgery
万方数据