Abstract：【Objective】To investigate the value of coagulation index and cystatin C (Cys C) in predicting AKI occurrence at 24 h after cardiac surgery. 【Methods】A total of 118 patients in our hospital received cardiac surgery were enrolled in the study.According to whether AKI occurred at 24 h after the operation,the patients were divided into the occurrence group (with AKI) and the non-occurring group (without AKI).The two groups of patients were compared with prothrombin time (PT),activated partial thromboplastin time (APTT),D-dimer (DD) and fibrinogen (FIB) at 2 h after surgery. The clinical data of two group were compared. Logistic multivariate regression analysis was used to evaluate the risk factors of AKI in patients. The predictive value of ROC at 2 h postoperatively in the occurrence of AKI in patients was analyzed. 【Results】Of the 118 patients,36 cases of AKI occurred 24 h after surgery,and the incidence was 30.51%.The levels of GFR,BUN,PT,APTT,DD,and Cys C at 2 h after the operation in the occurrence group were higher those in the non-occurring group,while the FIB level in the occurrence group was lower than that in the non-occurring group at 2 h after the operation (P<0.05).Logistic regression analysis showed that APTT,FIB,Cys C,and GFR at 2 h after the operation were all risk factors for AKI occurrence at 24 h after cardiac surgery (P<0.05).The ROC curve results showed that the area under the curve (AUC) of APTT,FIB,Cys C and the combination of the three in patients with cardiac surgery at 24 h after the operation were 0.819,0.760,0.757,and 0.902(P<0.05),respectively. 【Conclusion】Indicators of APTT,FIB and Cys C at 2 h postoperation have certain value in predicting the occurrence of AKI in patients with cardiac surgery 24 h postoperatively,and the combination of the three has even higher predictive value.
邓卫宁, 李景源. 凝血指标及胱抑素C对心脏手术患者术后24 h发生急性肾损伤的预测价值[J]. 医学临床研究, 2023, 40(5): 744-747.
DENG Wei-ning, LI Jing-yuan. Prognostic Value of Coagulation Index and Cystatin C for AKI Occurrence at 24 h after cardiac surgery. JOURNAL OF CLINICAL RESEARCH, 2023, 40(5): 744-747.
[1] RONCO C,BELLOMO R,KELLUM J A. Acute kidney injury[J].Lancet,2019,394(10212):1949-1964. [2] HARRISON T G,RUZYCKI S M,JAMES M T,et al. Estimated GFR and incidence of major surgery:a population-based cohort study[J].Am J Kidney Dis,2021,77(3):365-375. [3] VERBREE-WILLEMSEN L,ZHANG Y N,IBRAHIM I,et al. Extracellular vesicle Cystatin C and CD14 are associated with both renal dysfunction and heart failure[J].ESC Heart Fail,2020,7(5):2240-2249. [4] YUAN S M. Acute kidney injury after cardiac surgery:risk factors and novel biomarkers[J].Braz J Cardiovasc Surg,2019,34(3):352-360. [5] 美国改善全球肾脏病预后组织. KDIGO慢性肾脏病评价及管理临床实践指南[M].北京:人民卫生出版社,2014:48-51. [6] MUTLU H,GUNDUZ E,TITIZ T A,et al. Investigation of AKI with early biomarkers after cardiac surgery[J].Braz J Cardiovasc Surg,2020,35(5):722-731. [7] TSENG P Y,CHEN Y T,WANG C H,et al. Prediction of the development of acute kidney injury following cardiac surgery by machine learning[J].Crit Care,2020,24(1):478. [8] KINDGEN-MILLES D,SLOWINSKI T,DIMSKI T.New kidney function tests:Renal functional reserve and furosemide stress test[J].Med Klin Intensivmed Notfmed,2020,115(1):37-42. [9] THANAVARO J,TAYLOR J,VITT L,et al. Predictors and outcomes of acute kidney injury after cardiac surgery[J].Nephrol Nurs J,2019,46(1):31-40. [10] YANG J J,LEI W H,HU P,et al. Preoperative serum fibrinogen is associated with acute kidney injury after cardiac valve replacement surgery[J].Sci Rep,2020,10(1):6403. [11] 姜洁,吕菁君,叶璐,等. 可溶性血栓调节蛋白及中性粒细胞明胶酶相关脂质运载蛋白早期预测脓毒症相关急性肾损伤的临床研究[J].中华急诊医学杂志,2020,29(4):533-540. [12] 许明,芦乙滨,史川川. uNAG、sCysC在成人重症患者AKI中的水平变化及与预后的相关性分析[J].实验与检验医学,2019,37(2):282-284. [13] 刘芳,薛林霞. 血清CysC、尿β2-MG、L-FABP联合检测对心脏手术后急性肾损伤的早期诊断价值[J].中国医师杂志,2019,21(12):1817-1820.
2023, Vol. 40 
