Abstract：
OBJECTIVE: The multifactorial dynamic perfusion index was recently introduced as a predictor of cardiac surgery-associated acute kidney injury. The multifactorial dynamic perfusion index was developed based on retrospective data retrieved from the patient files. The present study aims to prospectively validate this index in an external series of patients, through an on-line measure of its various components.
METHODS: Inclusion criteria were adult patients undergoing cardiac surgery with cardiopulmonary bypass. Data collection included preoperative factors and cardiopulmonary bypass-related factors. These were collected on-line using a dedicated monitor. Factors composing the multifactorial dynamic perfusion index are the nadir haematocrit, the nadir oxygen delivery, the time of exposure to a low oxygen delivery, the nadir mean arterial pressure, cardiopulmonary bypass duration, the use of red blood cell transfusions and the peak arterial lactates.
RESULTS: Two hundred adult patients were investigated. The multifactorial dynamic perfusion index had a good (c-statistics 0.81) discrimination for cardiac surgery-associated acute kidney injury (any stage) and an excellent (c-statistics 0.93) discrimination for severe patterns (stage 2-3). Calibration was modest for cardiac surgery-associated acute kidney injury (any stage) and good for stage 2-3. The use of vasoconstrictors was an additional factor associated with cardiac surgery-associated acute kidney injury.
CONCLUSIONS: The multifactorial dynamic perfusion index is validated for discrimination of cardiac surgery-associated acute kidney injury risk. It incorporates modifiable risk factors, and may help in reducing the occurrence of cardiac surgery-associated acute kidney injury.
METHODS: Inclusion criteria were adult patients undergoing cardiac surgery with cardiopulmonary bypass. Data collection included preoperative factors and cardiopulmonary bypass-related factors. These were collected on-line using a dedicated monitor. Factors composing the multifactorial dynamic perfusion index are the nadir haematocrit, the nadir oxygen delivery, the time of exposure to a low oxygen delivery, the nadir mean arterial pressure, cardiopulmonary bypass duration, the use of red blood cell transfusions and the peak arterial lactates.
RESULTS: Two hundred adult patients were investigated. The multifactorial dynamic perfusion index had a good (c-statistics 0.81) discrimination for cardiac surgery-associated acute kidney injury (any stage) and an excellent (c-statistics 0.93) discrimination for severe patterns (stage 2-3). Calibration was modest for cardiac surgery-associated acute kidney injury (any stage) and good for stage 2-3. The use of vasoconstrictors was an additional factor associated with cardiac surgery-associated acute kidney injury.
CONCLUSIONS: The multifactorial dynamic perfusion index is validated for discrimination of cardiac surgery-associated acute kidney injury risk. It incorporates modifiable risk factors, and may help in reducing the occurrence of cardiac surgery-associated acute kidney injury.
摘要：
目的：最近引入了多因素动态灌注指数作为心脏手术相关急性肾损伤的预测指标。多因素动态灌注指数是基于从患者档案中检索到的回顾性数据开发的。本研究旨在在一系列外部患者中前瞻性地验证这一指标，通过在线测量其各个组成部分。
方法：纳入标准为：接受体外循环心脏手术的成年患者。数据收集包括术前因素，和体外循环相关因素。这些是使用专用监视器在线收集的。构成多因素动态灌注指数的因素是最低点血细胞比容，氧气输送的最低点，暴露于低氧输送的时间，平均动脉压最低点,体外循环持续时间，使用红细胞输血，和动脉乳酸盐峰值。
结果：对200百名成年患者进行了调查。多因素动态灌注指数对心脏手术相关的急性肾损伤（任何阶段）具有良好的区分（c统计0.81），对严重模式（2-3阶段）具有良好的区分（c统计0.93）。对于心脏手术相关的急性肾损伤（任何阶段），校准是适度的，对于2-3阶段良好。血管收缩剂的使用是与心脏手术相关的急性肾损伤相关的另一个因素。
结论：多因素动态灌注指数可用于鉴别心脏手术相关急性肾损伤风险。它包含了可修改的风险因素，并可能有助于减少心脏手术相关急性肾损伤的发生。
方法：纳入标准为：接受体外循环心脏手术的成年患者。数据收集包括术前因素，和体外循环相关因素。这些是使用专用监视器在线收集的。构成多因素动态灌注指数的因素是最低点血细胞比容，氧气输送的最低点，暴露于低氧输送的时间，平均动脉压最低点,体外循环持续时间，使用红细胞输血，和动脉乳酸盐峰值。
结果：对200百名成年患者进行了调查。多因素动态灌注指数对心脏手术相关的急性肾损伤（任何阶段）具有良好的区分（c统计0.81），对严重模式（2-3阶段）具有良好的区分（c统计0.93）。对于心脏手术相关的急性肾损伤（任何阶段），校准是适度的，对于2-3阶段良好。血管收缩剂的使用是与心脏手术相关的急性肾损伤相关的另一个因素。
结论：多因素动态灌注指数可用于鉴别心脏手术相关急性肾损伤风险。它包含了可修改的风险因素，并可能有助于减少心脏手术相关急性肾损伤的发生。
