Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Acta Anaesthesiol Scand. 2018 Nov;62(10):1374-1382. doi: 10.1111/aas.13210. Epub 2018 Jul 11.
The objective of this retrospective study was to determine the risk factors for acute kidney injury (AKI), including albumin, in children who underwent cardiac surgery. In addition, we evaluated the association between preoperative serum albumin level and postoperative AKI in these patients.
This retrospective study included 505 pediatric patients who underwent congenital cardiac surgery. Preoperative and perioperative risk factors for AKI, including serum albumin level, were assessed. AKI incidence within 7 postoperative days was determined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Multivariable logistic regression analysis was performed to evaluate the association between possible risk factors and postoperative AKI.
Of 505 pediatric patients, 185 (36.6%) developed postoperative AKI. The preoperative serum albumin level was associated with postoperative AKI (odds ratio [OR] 0.506, 95% confidence interval [CI] 0.325-0.788; P = 0.003). Other independent factors associated with AKI were age <12 months (OR 1.911, 95% CI 1.166-3.132; P = 0.007), preoperative pulmonary hypertension (OR 1.853, 95% CI 1.182-2.907; P = 0.01), and cardiopulmonary bypass (CPB) duration (OR 1.006, 95% CI 1.003-1.009; P = 0.002). Patients with AKI had higher incidence of postoperative complications, longer mechanical ventilation times, and more prolonged intensive care unit and hospital stays than patients without AKI.
Preoperative serum albumin level, age <12 months, preoperative pulmonary hypertension, and CPB duration were associated with risk for postoperative AKI in children who underwent congenital cardiac surgery.
本回顾性研究旨在确定行心脏手术的儿童发生急性肾损伤（AKI）的风险因素，包括白蛋白。此外，我们评估了这些患者术前血清白蛋白水平与术后 AKI 的相关性。
本回顾性研究纳入了 505 例行先天性心脏手术的儿科患者。评估了 AKI 的术前和围手术期风险因素，包括血清白蛋白水平。根据肾脏疾病：改善全球预后（KDIGO）标准确定术后 7 天内 AKI 的发生率。采用多变量逻辑回归分析评估可能的风险因素与术后 AKI 的关系。
505 例儿科患者中，185 例（36.6%）发生术后 AKI。术前血清白蛋白水平与术后 AKI 相关（比值比 [OR] 0.506，95%置信区间 [CI] 0.325-0.788；P=0.003）。与 AKI 相关的其他独立因素包括年龄<12 个月（OR 1.911，95% CI 1.166-3.132；P=0.007）、术前肺动脉高压（OR 1.853，95% CI 1.182-2.907；P=0.01）和体外循环（CPB）时间（OR 1.006，95% CI 1.003-1.009；P=0.002）。与无 AKI 患者相比，发生 AKI 的患者术后并发症发生率更高，机械通气时间更长，入住重症监护病房和住院时间更长。
行先天性心脏手术的儿童中，术前血清白蛋白水平、年龄<12 个月、术前肺动脉高压和 CPB 时间与术后 AKI 风险相关。
