SooHoo Megan McFerson, Patel Sonali S, Jaggers James, Faubel Sarah, Gist Katja M
1 Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, University of Colorado, Denver, CO, USA.
2 Section of Pediatric Cardiac Surgery, Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Denver, CO, USA.
World J Pediatr Congenit Heart Surg. 2018 Sep;9(5):513-521. doi: 10.1177/2150135118775413.
Both the Norwood procedure and acute kidney injury (AKI) are associated with significant morbidity and mortality. The impact of AKI by measured and fluid corrected serum creatinine on outcomes after the Norwood procedure has not been previously studied. The purpose of this study was to (1) identify the incidence of AKI, (2) determine AKI risk factors, and (3) evaluate outcomes in patients with AKI using both measured and fluid corrected serum creatinine.
Single-center retrospective chart review from 2009 to 2015 including neonates who underwent the Norwood procedure. Acute kidney injury was defined by the Kidney Disease Improving Global Outcomes staging criteria using both measured and fluid corrected serum creatinine. Multivariable logistic regression analysis was performed to determine the risk factors associated with AKI.
Ninety-five neonates underwent the Norwood procedure. Correcting for fluid overload increased the incidence of AKI from 40% to 44%, increased AKI severity in 15 patients, and improved the identification of adverse outcomes associated with AKI. Patients palliated with the modified Blalock-Taussig shunt (mBTS) had a 9.4 greater odds of fluid corrected AKI compared to those palliated with a right ventricle to pulmonary artery conduit (95% confidence interval [95% CI]: 1.68-52.26, P = .01). A higher vasoactive inotrope score (VIS) on postoperative day (POD) 0 was associated with fluid corrected AKI (odds ratio: 1.20, 95% CI: 1.06-1.35; P = .003).
Acute kidney injury is common after the Norwood procedure. Correcting creatinine for fluid balance revealed new cases of AKI. Use of an mBTS and higher VIS on POD 0 were associated with increased risk of AKI.
诺伍德手术和急性肾损伤（AKI）均与显著的发病率和死亡率相关。此前尚未研究通过实测及校正液体量后的血清肌酐来评估AKI对诺伍德手术后结局的影响。本研究的目的是：（1）确定AKI的发生率；（2）确定AKI的危险因素；（3）使用实测及校正液体量后的血清肌酐评估AKI患者的结局。
对2009年至2015年期间在单中心接受诺伍德手术的新生儿进行回顾性病历审查。根据改善全球肾脏病预后组织（KDIGO）分期标准，使用实测及校正液体量后的血清肌酐来定义急性肾损伤。进行多变量逻辑回归分析以确定与AKI相关的危险因素。
95例新生儿接受了诺伍德手术。校正液体超负荷后，AKI的发生率从40%增加到44%，15例患者的AKI严重程度增加，且改善了与AKI相关的不良结局的识别。与接受右心室至肺动脉导管姑息治疗的患者相比，接受改良布莱洛克-陶西格分流术（mBTS）姑息治疗的患者校正液体量后发生AKI的几率高9.4倍（95%置信区间[95%CI]：1.68 - 52.26，P = 0.01）。术后第0天（POD 0）较高的血管活性药物使用评分（VIS）与校正液体量后的AKI相关（比值比：1.20，95%CI：1.06 - 1.35；P = 0.003）。
诺伍德手术后急性肾损伤很常见。校正液体平衡后的肌酐水平发现了新的AKI病例。使用mBTS以及POD 0时较高的VIS与AKI风险增加相关。
