Value of different quantification methods for intraoperative hypotension in predicting postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass grafting
10.3760/cma.j.cn131073-20240801-00407
- VernacularTitle:术中低血压不同量化方法对OPCABG患者术后AKI的预测价值
- Author:
Zhao ZHANG
1
;
Jianxu ER
;
Wenqian ZHAI
;
Min REN
;
Bin YUAN
;
Jiange HAN
;
Zhigang GUO
Author Information
1. 天津大学胸科医院麻醉科，天津 300222
- Publication Type:Journal Article
- Keywords:
Hypotension;
Coronary artery bypass, off-pump;
Acute kidney injury;
Forecasting
- From:
Chinese Journal of Anesthesiology
2025;45(4):423-428
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the value of different quantification methods for intraoperative hypotension in predicting postoperative acute kidney injury (AKI) in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods:The medical records of American Society of Anesthesiologists Physical Status classification Ⅲ-Ⅳ patients of either sex, aged 18-80 yr, with a body mass index of 18-30 kg/m 2, scheduled for elective OPCABG, were retrospectively collected at Tianjin Chest Hospital from September 2021 to October 2023. Intraoperative hypotension was quantified using the methods such as the number of occurrence, average decrease in magnitude, duration, and the area under the threshold (mean arterial pressure <65 mmHg, 1 mmHg = 0.133 kPa). Patients were divided into AKI group and non-AKI group based on the occurrence of AKI within 7 days postoperatively. The extended logistic regression model was used to adjust for confounding factors, and the receiver operating characteristic curves were plotted to compare the accuracy of different methods for intraoperative hypotension in predicting postoperative AKI. Results:The results of multivariate logistic regression analysis showed that the frequency of hypotension ( OR=1.03, 95% confidence interval [ CI] 1.01-1.05, P=0.010), duration of hypotension ( OR=1.04, 95% CI 1.01-1.08, P=0.007), and area under the threshold ( OR=1.03, 95% CI 1.01-1.06, P=0.023) were risk factors for postoperative AKI. The areas under the curve for the quantification methods predicting the occurrence of postoperative AKI within 7 days, including the duration of hypotension, area under the threshold, frequency of hypotension, and mean decrease in blood pressure, were 0.751, 0.652, 0.647 and 0.513, respectively. Conclusions:The duration of hypotension, area under the threshold and frequency of hypotension are independent risk factors for postoperative AKI in patients undergoing OPCABG. The duration of hypotension has a higher accuracy in predicting the occurrence of postoperative AKI.
