Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
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Risk Factors for Development of Acute Renal Failure in Patient undergoing Open Heart Surgery

개심술 환자의 수술 후 급성 신부전 발생 위험요인

  • Received : 2013.01.16
  • Accepted : 2013.04.11
  • Published : 2013.04.30
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Abstract

The purpose of this study is to identify prognostic predictors of postoperative acute renal failure(ARF) for the patient undergoing cardiac surgery. Retrospectively review the electronic hospital database at a A hospital from Jan 2008 to Dec. 2011. 483 patients were included in this study. They were divided into a occurrence of ARF group(n=59) and a non occurrence of ARF group(n=424). ARF occurred in 59 cases (12.2%). Multi-variable logistic regression analysis identified that preoperative risk factors include creatinine(OR 3.92, p=<.001), advanced age(OR 2.142, p=.015), female(OR 2.165, p=.015), hypertension(OR 2.513, p=.005), NYHA(New York Heart Association) class II(OR 3.081, p=.003), and III(OR 6.759, p=.004), and intraoperative risk factor includes blood transfusion(OR 3.753, p=<.001), and postoperative factors include bilirubin(OR 4.541, p=.028), creatine(OR 8.554, p=.003), and cardiac output(OR 0.214, p=.033) as a prognostic predictors. The development of postoperative ARF could be a reason for increase in rate of complication and mortality after cardiac surgery. therefore the prevention of ARF is of paramount importance and treatment strategies are urgently needed.

본 연구의 목적은 개심술 후 급성 신부전 발생 빈도와 급성 신부전 발생의 예측요인을 분석하기 위함이다. 2008년 1월에서 2011년 12월까지 A 대학병원에서 개심술을 시행한 483명을 대상으로 전자의무기록을 후향적으로 조사하여 복막투석, 혈액투석, 지속적신대체요법을 사용한 급성 신부전 발생군(n=59)과 신대체 요법을 시행하지 않은 대조군(n=424)으로 분류하였다. 연구결과 개심술 후 급성 신부전 발생률은 12.2%로 나타났다. 다변량 로지스틱 회귀분석 결과 수술 전 위험요소로는 크레아티닌(OR 3.92, p=<.001), 고령(OR 2.142, p=.015), 여자(OR 2.165, p=.015), 고혈압(OR 2.513, p=.005), NYHA(New York Heart Association) class II(OR 3.081, p=.003), NYHA class III(OR 6.759, p=.004)이었으며, 수술 중 위험요소로는 수혈량(OR 3.753, p=<.001), 수술 후 위험요소로는 빌리루빈(OR 4.541, p=.028), 크레아티닌(OR 8.554, p=.003), 심박출량(OR 0.214, p=.033)이 의미 있는 예측인자로 확인되었다. 심장수술 후 급성 신부전 발생은 합병증과 사망률을 증가시키는 원인이 되므로 조기에 위험인자를 발견하여 예방하는 것이 중요하다.

Keywords

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