Correlacao do EuroSCORE com o surgimento de lesao renal aguda pos-operatoria em cirurgia cardiaca / Correlation of the EuroSCORE with the onset of postoperative acute kidney injury in cardiac surgery

RESUMO

OBJETIVO: Verificar se há correlação entre valores do EuroSCORE e o risco de desenvolver lesão renal aguda em pacientes submetidos à cirurgia cardíaca. MÉTODOS: Estudo retrospectivo, realizado em hospital terciário, em pacientes consecutivos com indicação para abordagem cirúrgica cardíaca (valvares, isquêmicas e congênitas) entre outubro de 2010 a julho de 2011. RESULTADOS: Foram avaliados cem pacientes. Destes, seis foram excluídos (cinco por doença renal ou terapia dialítica prévias e um devido a informações incompletas no prontuário médico). As principais indicações cirúrgicas foram revascularização miocárdica em 55 pacientes (58,5% dos casos) e trocas valvares em 28 pacientes (29,8%). Conforme o EuroSCORE, 55 pacientes foram classificados como risco alto (58,5%), 27 pacientes como risco médio (28,7%) e 12 pacientes como risco baixo (12,8%). No período pós-operatório, 31 pacientes (33%) evoluíram com aumento da creatinina sérica (18 (19,1%) RIFLE "R"; 7 (7,4%) RIFLE "I"; e 6 (6,5%) RIFLE "F"). Na amostra considerada de alto risco pelos critérios do EuroSCORE, 24 pacientes (43,6%) apresentaram comprometimento renal agudo. Nos pacientes classificados como de médio e de baixo risco, ocorreu lesão renal aguda em 18,5 e 16,6% dos casos, respectivamente. A associação entre a estratificação de risco (baixo, médio e alto) do EuroSCORE e o escore do RIFLE pós-operatório foi estatisticamente significante (p=0,03). CONCLUSÃO: Na população estudada, houve correlação estatisticamente significante entre o EuroSCORE e o risco de desenvolvimento de lesão renal aguda no pós-operatório de cirurgia cardíaca. .

ABSTRACT

OBJECTIVE: The objective of this study was to assess the correlation between the European System for Cardiac Operative Risk Evaluation (EuroSCORE) score and the risk of developing acute kidney injury in cardiac surgery patients. METHODS: This retrospective study was conducted at a tertiary hospital on consecutive cardiac surgery patients (e.g., valvular, ischemic and congenital heart diseases) between October 2010 and July 2011. RESULTS: One hundred patients were assessed. Among the 100 patients, six were excluded, including five because of prior kidney disease or dialysis therapy and one because of incomplete medical records. The primary surgical indications were myocardial revascularization in 55 patients (58.5% of cases) and valve replacement in 28 patients (29.8%). According to the EuroSCORE, 55 patients were classified as high risk (58.5%), 27 patients as medium risk (28.7%) and 12 patients as low risk (12.8%). In the postoperative period, patients were classified with the Risk, Injury, Failure, Loss and End-stage kidney disease (RIFLE) score. Among the 31 patients (33%) who displayed an increase in serum creatinine, 18 patients (19.1%) were classified as RIFLE "R" (risk), seven patients (7.4%) were classified as RIFLE "I" (injury) and six patients (6.5%) were classified as RIFLE "F" (failure). Among the patients who were considered to be high risk according to the EuroSCORE criteria, 24 patients (43.6%) showed acute kidney injury. Among the patients who were classified as medium or low risk, acute kidney injury occurred in 18.5 and 16.6% of the cases, respectively. The correlations between risk stratification (low, medium and high) and the EuroSCORE and postoperative RIFLE scores were statistically significant (p=0.03). CONCLUSION: In the studied population, there was a statistically significant correlation between the EuroSCORE and the risk of developing acute kidney injury in the postoperative period after cardiac surgery. .