接受心脏瓣膜手术的患者需要抗凝预防以降低血栓形成的风险。华法林通常是一种选择,但其剂量因基因和临床因素而异。我们的目标是学习,其中,如果急性肾损伤与本研究的两个基因多态性之间存在相互作用。我们从医疗中心的电子健康记录(EHR)系统中提取了心脏瓣膜手术接受者的数据。主要结果是华法林的平均每日剂量,作为急性肾损伤(AKI)和华法林相关基因多态性之间的累加相互作用效应(INTadd)。混杂因素,包括年龄,性别,体表面积(BSA),合并症(即,心房颤动[AF],高血压[HTN],充血性心力衰竭[CHF]),血清白蛋白水平,华法林相关基因多态性(即CYP2C9,VKORC1),人工瓣膜类型(即,金属,bio),和华法林病史通过多元线性回归模型进行控制.该研究包括200名患者,其中女性108人(54.00%)。Further,平均年龄是54.45岁,31(15.50%)有瑞士法郎,40例(20.00%)患者同时服用胺碘酮,这可能与华法林预防期重叠。在后续行动中,30例(15.00%)患者发生AKI。VKORC1突变(1639G>A)发生在25例(12.50%)患者中,CYPC29*2或*3突变出现在20例(10.00%)患者中。我们发现AKI和VKORC1之间存在显著的累加相互作用效应(-1.17,95%CI-1.82至-0.53,p=0.0004)。该结果表明,在抗凝预防的初始阶段,华法林剂量的急性肾损伤与VKORC1多态性之间可能存在相互作用。
Patients who receive heart valve surgery need anticoagulation prophylaxis to reduce the risk of thrombosis. Warfarin often is a choice but its dosage varies due to gene and clinical factors. We aim to study, among them, if there is an interaction between acute kidney injury and two gene polymorphisms from this study. We extracted data of heart valve surgery recipients from the electronic health record (EHR) system of a medical center. The primary outcome is about the average daily dose of warfarin, measured as an additive interaction effect (INTadd) between acute kidney injury (AKI) and warfarin-related gene polymorphisms. The confounders, including age, sex, body surface area (BSA), comorbidities (i.e., atrial fibrillation [AF], hypertension [HTN], congestive heart failure [CHF]), serum albumin level, warfarin-relevant gene polymorphism (i.e., CYP2C9, VKORC1), prosthetic valve type (i.e., metal, bio), and warfarin history were controlled via a multivariate-linear regression model. The study included 200 patients, among whom 108 (54.00%) are female. Further, the mean age is 54.45 years, 31 (15.50%) have CHF, and 40 (20.00%) patients were prescribed concomitant amiodarone, which potentially overlays with the warfarin prophylaxis period. During the follow-up, AKI occurred in 30 (15.00%) patients. VKORC1 mutation (1639G>A) occurred in 25 (12.50%) patients and CYPC29 *2 or *3 mutations presented in 20 patients (10.00%). We found a significant additive interaction effect between AKI and VKORC1 (- 1.17, 95% CI - 1.82 to - 0.53, p = 0.0004). This result suggests it is probable that there is an interaction between acute kidney injury and the VKORC1 polymorphism for the warfarin dose during the initial period of anticoagulation prophylaxis.