Department of Interventional and Surgical Cardiology, Heart Centre, Universitair Ziekenhuis Gent, De Pintelaan 185, B-9000 Gent, Belgium.
Crit Care. 2011 Aug 10;15(4):R192. doi: 10.1186/cc10349.
Acute kidney injury (AKI) is common after cardiac operations. There are different risk factors or determinants of AKI, and some are related to cardiopulmonary bypass (CPB). In this study, we explored the association between metabolic parameters (oxygen delivery (DO2) and carbon dioxide production (VCO2)) during CPB with postoperative AKI.
We conducted a retrospective analysis of prospectively collected data at two different institutions. The study population included 359 adult patients. The DO2 and VCO2 levels of each patient were monitored during CPB. Outcome variables were related to kidney function (peak postoperative serum creatinine increase and AKI stage 1 or 2). The experimental hypothesis was that nadir DO2 values and nadir DO2/VCO2 ratios during CPB would be independent predictors of AKI. Multivariable logistic regression models were built to detect the independent predictors of AKI and any kind of kidney function damage.
A nadir DO2 level < 262 mL/minute/m2 and a nadir DO2/VCO2 ratio < 5.3 were independently associated with AKI within a model including EuroSCORE and CPB duration. Patients with nadir DO2 levels and nadir DO2/VCO2 ratios below the identified cutoff values during CPB had a significantly higher rate of AKI stage 2 (odds ratios 3.1 and 2.9, respectively). The negative predictive power of both variables exceeded 90%. The most accurate predictor of AKI stage 2 postoperative status was the nadir DO2 level.
The nadir DO2 level during CPB is independently associated with postoperative AKI. The measurement of VCO2-related variables does not add accuracy to the AKI prediction. Since DO2 during CPB is a modifiable factor (through pump flow adjustments), this study generates the hypothesis that goal-directed perfusion management aimed at maintaining the DO2 level above the identified critical value might limit the incidence of postoperative AKI.
心脏手术后常发生急性肾损伤（AKI）。AKI 的危险因素或决定因素有很多，其中一些与体外循环（CPB）有关。在这项研究中，我们探讨了 CPB 期间代谢参数（氧输送（DO2）和二氧化碳产生（VCO2））与术后 AKI 的关系。
我们对两个不同机构前瞻性收集的数据进行了回顾性分析。研究人群包括 359 名成年患者。每位患者在 CPB 期间监测 DO2 和 VCO2 水平。观察结果与肾功能有关（术后血清肌酐峰值升高和 AKI 1 或 2 期）。实验假设是 CPB 期间的最低 DO2 值和最低 DO2/VCO2 比值是 AKI 的独立预测因子。建立多变量逻辑回归模型以检测 AKI 和任何类型肾功能损害的独立预测因子。
在包括 EuroSCORE 和 CPB 持续时间的模型中，最低 DO2 值<262 mL/minute/m2 和最低 DO2/VCO2 比值<5.3 与 AKI 独立相关。CPB 期间最低 DO2 值和最低 DO2/VCO2 比值低于确定的临界值的患者 AKI 2 期的发生率明显更高（比值比分别为 3.1 和 2.9）。两个变量的阴性预测能力均超过 90%。AKI 2 期术后状态的最佳预测因子是最低 DO2 值。
CPB 期间的最低 DO2 值与术后 AKI 独立相关。与 VCO2 相关的变量测量对 AKI 预测没有增加准确性。由于 CPB 期间的 DO2 是一个可调节的因素（通过泵流量调整），因此本研究提出了一个假设，即旨在将 DO2 水平维持在确定的临界值以上的目标导向灌注管理可能会限制术后 AKI 的发生率。
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