文献类型：期刊文献

英文题名：Longitudinal hemoglobin trajectories and acute kidney injury in patients undergoing cardiac surgery: a retrospective cohort study

作者：Zhu, Shouqiang[1];Lu, Peng[2];Liu, Zhenran[3,4,5];Li, Shaoyang[6];Li, Peitong[7];Wei, Bingdi[8];Li, Jiayi[2];Wang, Yupei[9]

第一作者：Zhu, Shouqiang

通信作者：Wang, YP[1]

机构：[1]Fourth Mil Med Univ, Xijing Hosp, Dept Anesthesiol & Perioperat Med, Xian, Peoples R China;[2]Gansu Univ Chinese Med, Clin Med Coll 1, Lanzhou, Peoples R China;[3]Anhui Med Univ, Affiliated Hosp 1, Dept Obstet & Gynecol, Hefei, Peoples R China;[4]Anhui Med Univ, NHC Key Lab Study Abnormal Gametes & Reprod Tract, Hefei, Peoples R China;[5]Anhui Med Univ, Minist Educ Peoples Republ China, Key Lab Populat Hlth Life Cycle, Hefei, Peoples R China;[6]Anhui Med Univ, Clin Med Coll 2, Hefei, Peoples R China;[7]Zhejiang Univ Tradit Chinese Med, Clin Med Coll 3, Hangzhou, Zhejiang, Peoples R China;[8]Gansu Univ Chinese Med, Sch Publ Hlth, Lanzhou, Peoples R China;[9]Gansu Prov Matern & Child Care Hosp, Ctr Med Genet, Gansu Prov Clin Res Ctr Birth Defects & Rare Dis, Lanzhou, Peoples R China

第一机构：Fourth Mil Med Univ, Xijing Hosp, Dept Anesthesiol & Perioperat Med, Xian, Peoples R China

通信机构：[1]corresponding author), Gansu Prov Matern & Child Care Hosp, Ctr Med Genet, Gansu Prov Clin Res Ctr Birth Defects & Rare Dis, Lanzhou, Peoples R China.

年份：2023

卷号：10

外文期刊名：FRONTIERS IN CARDIOVASCULAR MEDICINE

收录：;Scopus(收录号：2-s2.0-85161035485);WOS:【SCI-EXPANDED(收录号:WOS:000997166500001)】；

语种：英文

外文关键词：anemia; acute kidney injury; cardiopulmonary bypass; transfusion; trajectory

摘要：ObjectThe purpose of this study was to describe the longitudinal dynamic hemoglobin trajectories in patients undergoing cardiac surgery and to explore whether they provide a broader perspective in predicting AKI compared to traditional threshold values. Additionally, the interaction of red blood cell transfusion was also investigated.MethodsThe MIMIC-IV database was searched to identify patients undergoing cardiac surgery with cardiopulmonary bypass. Group-based trajectory modeling (GBTM) was used to determine the hemoglobin trajectories in the first 72 h after ICU admission. The correlation between hemoglobin trajectories and AKI was evaluated using multivariable logistic regression and inverse probability of treatment weighting. Receiver operating characteristic (ROC) curves were created in the dataset to further validate previously reported thresholds.ResultsA total of 4,478 eligible patients were included in this study. Three hemoglobin trajectories were identified by GBTM, which were significantly different in the initial hemoglobin level and evolution pattern. Compared to the "the lowest, rising, and then declining" trajectory, patients in the "the highest, declining" and "medium, declining" trajectory groups had significantly lower AKI risk (OR 0.56; 95% CI 0.48, 0.67) and (OR 0.70; 95% CI 0.55, 0.90), respectively. ROC analysis yielded a disappointing result, with an AUC of 0.552, sensitivity of 0.25, and specificity of 0.86 when the hemoglobin threshold was set at 8 g/dl in the entire cohort. In the subgroup analysis of red blood cell transfusion, hemoglobin levels above 10 g/dl predicted higher AKI risk, and there was no correlation between hemoglobin trajectories and AKI in the non-red blood cell transfusion subgroup.ConclusionThis study identified a hemoglobin trajectory that is associated with an increased risk of AKI after cardiac surgery. It is noteworthy that fixed hemoglobin thresholds should not be applied to all patient types. In patients receiving red blood cell transfusion, maintaining hemoglobin levels above 10 g/dl through transfusion was associated with an increased risk of AKI.