Fatores de risco para lesão renal aguda após cirurgia cardíaca

Abstract

Objective: The objective of the present investigation was to identify risk factors for acute kidney injury in patients with normal levels of serum creatinine who underwent coronary artery bypass graft (CABG) surgery and/or valve surgery. Methods: Data from a cohort of 769 patients, after the exclusion criteria were applied, were analyzed using bivariate analyses and binary logistic regression modeling. Results: Three hundred eighty one patients experienced CABG, 339 valve surgery and 49 went through both simultaneously. Forty six percent of the patients were female and the mean age was 57±14 years (13 to 89 years). Seventy eight patients presented renal dysfunction postoperatively (10%), 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 risk factors that were independently associated with AKI 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 who underwent 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 AKI.