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Abstract：
BACKGROUND: Acute kidney injury (AKI) remains a common complication of coronary revascularization and increases poor outcomes in critically ill surgical patients. Compared to the plasma volume status (PVS), estimated plasma volume status (ePVS) has the advantages of being noninvasive and simple and has been shown to be associated with worse prognosis in patients undergoing coronary revascularization. This study was to evaluate the association of ePVS with the risk of AKI in patients who underwent coronary revascularization.
METHODS: In this retrospective cohort study, data of patients who underwent coronary revascularization were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database (2008-2019). The outcome was the occurrence of AKI after ICU admission. The covariates were screened via the LASSO regression method. Univariate and multivariate Logistic regression models were performed to assess the association of ePVS and PVS and the odds of AKI in patients who underwent coronary revascularization, with results shown as odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses of age, surgery, and anticoagulation agents and sequential organ failure assessment (SOFA) score were performed to further explore the association of ePVS with AKI.
RESULTS: A total of 3,961 patients who underwent coronary revascularization were included in this study, of whom 2,863 (72.28%) had AKI. The high ePVS was associated with the higher odds of AKI in patients who received coronary revascularization (OR = 1.06, 95%CI: 1.02-1.10), after adjusting for the covariates such as age, race, SAPS-II score, SOFA score, CCI, weight, heart rate, WBC, RDW-CV, PT, BUN, glucose, calcium, PH, PaO2, mechanical ventilation, vasopressors, and diuretic. Similar results were found in patients who underwent the CABG (OR = 1.07, 95%CI: 1.02-1.11), without anticoagulation agents use (OR = 1.07, 95%CI: 1.03-1.12) and with high SOFA score (OR = 1.10, 95%CI: 1.04-1.17). No relationship was found between PVS and the odds of AKI in patients who underwent the coronary revascularization.
CONCLUSIONS: The ePVS may be a promising parameter to evaluate the risk of AKI in patients undergoing coronary revascularization, which provides a certain reference for the risk stratification management of ICU patients who underwent coronary revascularization.
METHODS: In this retrospective cohort study, data of patients who underwent coronary revascularization were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database (2008-2019). The outcome was the occurrence of AKI after ICU admission. The covariates were screened via the LASSO regression method. Univariate and multivariate Logistic regression models were performed to assess the association of ePVS and PVS and the odds of AKI in patients who underwent coronary revascularization, with results shown as odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses of age, surgery, and anticoagulation agents and sequential organ failure assessment (SOFA) score were performed to further explore the association of ePVS with AKI.
RESULTS: A total of 3,961 patients who underwent coronary revascularization were included in this study, of whom 2,863 (72.28%) had AKI. The high ePVS was associated with the higher odds of AKI in patients who received coronary revascularization (OR = 1.06, 95%CI: 1.02-1.10), after adjusting for the covariates such as age, race, SAPS-II score, SOFA score, CCI, weight, heart rate, WBC, RDW-CV, PT, BUN, glucose, calcium, PH, PaO2, mechanical ventilation, vasopressors, and diuretic. Similar results were found in patients who underwent the CABG (OR = 1.07, 95%CI: 1.02-1.11), without anticoagulation agents use (OR = 1.07, 95%CI: 1.03-1.12) and with high SOFA score (OR = 1.10, 95%CI: 1.04-1.17). No relationship was found between PVS and the odds of AKI in patients who underwent the coronary revascularization.
CONCLUSIONS: The ePVS may be a promising parameter to evaluate the risk of AKI in patients undergoing coronary revascularization, which provides a certain reference for the risk stratification management of ICU patients who underwent coronary revascularization.
摘要：
背景：急性肾损伤（AKI）仍然是冠状动脉血运重建的常见并发症，并增加了危重手术患者的不良预后。与血浆容量状态（PVS）相比，估计血浆容量状态(ePVS)具有无创和简单的优点,并且已被证明与冠状动脉血运重建患者的预后较差相关.这项研究旨在评估接受冠状动脉血运重建的患者中ePVS与AKI风险的相关性。
方法：在这项回顾性队列研究中，我们从重症监护医学信息集市(MIMIC)-IV数据库(2008-2019)中提取了接受冠状动脉血运重建的患者数据.结果为入住ICU后AKI的发生。通过LASSO回归方法筛选协变量。采用单因素和多因素Logistic回归模型评估ePVS和PVS的相关性以及冠状动脉血运重建患者发生AKI的几率。结果显示为比值比(OR)和95%置信区间(CI)。年龄亚组分析，手术,抗凝药物和序贯器官衰竭评估(SOFA)评分,进一步探讨ePVS与AKI的相关性.
结果：本研究共纳入3,961例接受冠状动脉血运重建的患者，其中2,863人（72.28%）患有AKI。在接受冠状动脉血运重建的患者中，高ePVS与AKI的几率更高(OR=1.06,95CI:1.02-1.10)。在调整了年龄等协变量后，种族,SAPS-II得分,SOFA得分,CCI,体重,心率,WBC,RDW-CV,PT,BUN,葡萄糖，钙，PH,氧分压，机械通气，血管升压药,和利尿剂.在接受CABG的患者中发现了类似的结果（OR=1.07，95CI：1.02-1.11），未使用抗凝剂（OR=1.07，95CI：1.03-1.12）和高SOFA评分（OR=1.10，95CI：1.04-1.17）。在接受冠状动脉血运重建的患者中，PVS与AKI的几率之间没有发现关系。
结论：ePVS可能是评估冠状动脉血运重建患者AKI风险的一个有希望的参数，为ICU冠脉血运重建患者的风险分层管理提供了一定的参考。
方法：在这项回顾性队列研究中，我们从重症监护医学信息集市(MIMIC)-IV数据库(2008-2019)中提取了接受冠状动脉血运重建的患者数据.结果为入住ICU后AKI的发生。通过LASSO回归方法筛选协变量。采用单因素和多因素Logistic回归模型评估ePVS和PVS的相关性以及冠状动脉血运重建患者发生AKI的几率。结果显示为比值比(OR)和95%置信区间(CI)。年龄亚组分析，手术,抗凝药物和序贯器官衰竭评估(SOFA)评分,进一步探讨ePVS与AKI的相关性.
结果：本研究共纳入3,961例接受冠状动脉血运重建的患者，其中2,863人（72.28%）患有AKI。在接受冠状动脉血运重建的患者中，高ePVS与AKI的几率更高(OR=1.06,95CI:1.02-1.10)。在调整了年龄等协变量后，种族,SAPS-II得分,SOFA得分,CCI,体重,心率,WBC,RDW-CV,PT,BUN,葡萄糖，钙，PH,氧分压，机械通气，血管升压药,和利尿剂.在接受CABG的患者中发现了类似的结果（OR=1.07，95CI：1.02-1.11），未使用抗凝剂（OR=1.07，95CI：1.03-1.12）和高SOFA评分（OR=1.10，95CI：1.04-1.17）。在接受冠状动脉血运重建的患者中，PVS与AKI的几率之间没有发现关系。
结论：ePVS可能是评估冠状动脉血运重建患者AKI风险的一个有希望的参数，为ICU冠脉血运重建患者的风险分层管理提供了一定的参考。
