Department of Pediatric Critical Care Medicine, Xinhua Hospital, Affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Yangpu District, Shanghai 200092, China.
Cardiol Young. 2022 Apr;32(4):558-563. doi: 10.1017/S1047951121002559. Epub 2021 Jul 2.
Acute kidney injury is a severe complication following complete repair of tetralogy of Fallot. Anaerobic metabolism is believed to contribute to the development of acute kidney injury. The ratio of central venous to arterial carbon dioxide tension to arterio-venous oxygen content (PV-ACO2/CA-VO2) has been proposed as a surrogate for respiratory quotient and an indicator of tissue oxygenation. We hypothesised that a small increase of PV-ACO2/CA-VO2 might have superior discrimination ability in subsequent acute kidney injury prediction.
This study is retrospective and single-centre design study. The study population consisted of 61 children with tetralogy of Fallot that underwent a complete surgical repair between July 2017 and January 2021. Baseline characteristics and intra-operative parameters were collected through a retrospective chart review. PV-ACO2/CA-VO2 was collected within 12 hours of surgical completion. Acute kidney injury was defined according to the criteria established by the Kidney Disease: Improving Global Outcomes group. Univariate and logistic regression analyses were performed to determine risk factors for acute kidney injury.
Of the 61 patients, 20 (32.8%) developed acute kidney injury. Multivariate logistic analyses showed that age, height, haematocrit, and Pv-aCO2/Ca-vO2 were independently associated with the development of acute kidney injury. The addition of Pv-aCO2/Ca-vO2 to the model significantly increased model discrimination [AUROC 0.939 (95% CI 0.894-0.984) and AUROC 0.922 (95% CI 0.869-0.975), respectively].
The increase of PV-ACO2/CA-VO2 could improve the predictive ability for subsequent development of acute kidney injury in children with tetralogy of Fallot.
急性肾损伤是法洛四联症完全修复后的严重并发症。无氧代谢被认为是导致急性肾损伤的原因之一。中心静脉二氧化碳分压与动脉血氧含量的比值（PV-ACO2/CA-VO2）被提议作为呼吸商的替代物和组织氧合的指标。我们假设 PV-ACO2/CA-VO2 的小幅度增加可能具有更好的预测随后发生急性肾损伤的能力。
这是一项回顾性和单中心设计研究。研究人群包括 2017 年 7 月至 2021 年 1 月期间接受完全手术修复的 61 例法洛四联症患儿。通过回顾性图表审查收集基线特征和术中参数。在手术完成后 12 小时内收集 PV-ACO2/CA-VO2。急性肾损伤根据肾脏病：改善全球结果组织制定的标准定义。进行单变量和逻辑回归分析以确定急性肾损伤的危险因素。
在 61 例患者中，有 20 例（32.8%）发生急性肾损伤。多变量逻辑分析显示，年龄、身高、红细胞压积和 Pv-aCO2/Ca-vO2 与急性肾损伤的发生独立相关。PV-ACO2/CA-VO2 的加入显著提高了模型的区分度[AUROC 分别为 0.939（95%CI 0.894-0.984）和 0.922（95%CI 0.869-0.975）]。
PV-ACO2/CA-VO2 的增加可以提高法洛四联症患儿随后发生急性肾损伤的预测能力。
