Ali Fatima, Khan Misha Khalid, Mirza Bilal, Qureshi Sonia, Abbas Qalab
Pediatrics and Child Health, Aga Khan University Hospital, Karachi, PAK.
Cureus. 2020 Apr 18;12(4):e7727. doi: 10.7759/cureus.7727.
Background Acute kidney injury (AKI) is a commonly recognized clinical problem after congenital heart disease (CHD) surgery. Increased perioperative morbidity, development of chronic kidney disease, and increased mortality are the major concerns. We investigated frequency, risk factors, and outcomes of AKI after CHD surgery at our hospital. Methods This study was a retrospective analytic review conducted from January 2013 to October 2016 on patients aged between 1 month and 45 years who underwent cardiopulmonary bypass (CPB) for CHD surgery. The modified Kidney Disease Improving Global Outcomes criteria based on serum creatinine value was adopted to diagnose AKI. We assessed AKI frequency and its staging, and outcomes as AKI resolution, length of stay, and mortality. Stages II and III (plasma creatinine level two or more times the baseline) were labeled as severe AKI. Univariate and multivariate logistic regression analyses were conducted, and results were reported as mean with standard deviation and as frequencies with percentage. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported for factors associated with the development of AKI. Results Of the 840 patients who underwent CHD surgery, 237 (28%) developed AKI. AKI stages II1 and III were seen in 101 (42%) and 103 (43%) patients, respectively. Prolonged CPB time > 120 minutes (adjusted OR [AOR]: 1.87; 95% CI: 1.22-2.88; p = 0.004) and hemoglobin > 16 gm/dL (AOR: 1.80; 95% CI: 1.16-2.78; p = 0.008) were associated with the development of AKI on multivariate analysis. AKI resolved spontaneously in 222 (94%) patients, and 10 (4%) patients who developed AKI died. Conclusions Most patients with AKI showed spontaneous resolution. Prolonged CPB time and increased hemoglobin were found to be significant risk factors. Our study found spontaneous resolution of AKI in most cases. However, preplanning and careful monitoring in patients with expected prolonged CPB time and increased baseline hemoglobin can prevent and identify AKI at an early stage.
急性肾损伤（AKI）是先天性心脏病（CHD）手术后常见的临床问题。围手术期发病率增加、慢性肾脏病的发生以及死亡率上升是主要关注点。我们调查了我院CHD手术后AKI的发生率、危险因素及预后情况。
本研究是一项回顾性分析，对2013年1月至2016年10月期间年龄在1个月至45岁之间接受CHD手术并进行体外循环（CPB）的患者进行。采用基于血清肌酐值的改良全球肾脏病改善预后标准来诊断AKI。我们评估了AKI的发生率及其分期，以及AKI缓解、住院时间和死亡率等预后情况。将II期和III期（血浆肌酐水平为基线的两倍或更高）定义为严重AKI。进行单因素和多因素逻辑回归分析，结果以均值±标准差和频率及百分比的形式报告。报告与AKI发生相关因素的比值比（OR）及95%置信区间（CI）。
在840例接受CHD手术的患者中，237例（28%）发生了AKI。分别有101例（42%）和103例（43%）患者出现AKI II期和III期。多因素分析显示，CPB时间延长>120分钟（校正OR[AOR]：1.87；95%CI：1.22 - 2.88；p = 0.004）和血红蛋白>16 g/dL（AOR：1.80；95%CI：1.16 - 2.78；p = 0.008）与AKI的发生相关。222例（94%）发生AKI的患者自发缓解，10例（4%）发生AKI的患者死亡。
大多数AKI患者表现为自发缓解。发现CPB时间延长和血红蛋白升高是重要的危险因素。我们的研究发现大多数情况下AKI可自发缓解。然而，对于预计CPB时间延长和基线血红蛋白升高的患者，进行预先规划和仔细监测可以预防并早期识别AKI。
