Fatores de risco para lesão renal aguda após cirurgia cardíaca

Autor: Alfredo José Rodrigues, Lafaiete Alves Junior, Wesley Ferreira Araújo, Paulo Roberto Barbosa Evora, Adilson Scorzoni Filho, Walter Villela de Andrade Vicente, Solange Bassetto
Rok vydání: 2009
Předmět:
Zdroj: Brazilian Journal of Cardiovascular Surgery v.24 n.4 2009
Brazilian Journal of Cardiovascular Surgery
Sociedade Brasileira de Cirurgia Cardiovascular (SBCCV)
instacron:SBCCV
Brazilian Journal of Cardiovascular Surgery, Volume: 24, Issue: 4, Pages: 441-446, Published: DEC 2009
ISSN: 0102-7638
DOI: 10.1590/s0102-76382009000500003
Popis: OBJETIVO: Identificar fatores de risco associados à lesão renal aguda em pacientes com níveis séricos normais de creatinina sérica que foram submetidos à revascularização cirúrgica do miocárdio e/ou cirurgia valvar. MÉTODOS: Os dados de uma coorte de 769 pacientes foram analisados utilizando análise bivariável e regressão logística binária. RESULTADOS: Trezentos e oitenta e um pacientes foram submetidos à revascularização isolada, 339 a cirurgia valvar e 49 a ambas. Quarenta e seis por cento dos pacientes eram do sexo feminino e a idade média foi 57 ± 14 anos. Setenta e oito (10%) pacientes apresentavam disfunção renal no pósoperatório, 23% destes necessitaram hemodiálise. A mortalidade geral foi 10%. A mortalidade para pacientes com disfunção renal pós-operatória foi de 40% (versus 7%, P 120 minutos (P = 0,001, OR: 7,040), doença arterial periférica (P = 0,107, 2,296). CONCLUSÃO: A disfunção renal foi a disfunção orgânica pós-operatória mais frequente em pacientes submetidos à revascularização do miocárdio e/ou cirurgia valvar e idade, presença de insuficiência cardíaca, DPOC, endocardite, infarto do miocárdio < 30 dias, doença arterial periférica, cirurgia valvar e tempo de circulação extracorpórea > 120 minutos foram os fatores de risco independentemente associados à lesão renal aguda. OBJECTIVE: The aim of the present study was to identify risk factors for acute renal failure in patients with normal levels of serum creatinine who had undergone coronary artery bypass graft (CABG) surgery and/or valve surgery. METHODS: Data from a cohort of 769 patients were assessed using bivariate analyses and binary logistic regression modeling. RESULTS: Three hundred eighty one patients underwent CABG, 339 valve surgery and 49 had undergone both simultaneously. Forty six percent of the patients were female and the mean age was 57 ± 14 years (13 to 89 years). Seventy eight (10%) patients presented renal dysfunction postoperatively, of these 23% needed hemodialysis (2.4% of all patients). The mortality for the whole cohort was 10%. The overall mortality for patients experiencing postoperative renal dysfunction was 40% (versus 7%, P < 0.001), 29% for those who did not need dialysis and 67% for those who needed dialysis (P = 0.004). The independent risk factors found were: age (P < 0.000, OR: 1.056), congestive heart failure (P = 0.091, OR: 2.238), COPD (P = 0.003, OR: 4.111), endocarditis (P = 0.001, OR: 12.140), myocardial infarction < 30 days (P = 0.015, OR: 4.205), valve surgery (P = 0.016, OR: 2.137), cardiopulmonary bypass time > 120 min (P = 0.001, OR: 7.040), peripheral arterial vascular disease (P = 0.107, 2.296). CONCLUSION: Renal dysfunction was the most frequent postoperative organ dysfunction in patients undergone CABG and/or valve surgery and age, congestive heart failure, COPD, endocarditis, myocardial infarction < 30 days, valve surgery, cardiopulmonary bypass time >120 min, and peripheral arterial vascular disease were the risk factors independently associated with acute renal failure (ARF).
Databáze: OpenAIRE
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