Cao Fan, Chen Xinxin, Huang Guodong, Liu Wenhua, Zhou Na, Yuan Huili, Zou Minghui
Department of Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Front Pediatr. 2021 Jul 19;9:682839. doi: 10.3389/fped.2021.682839. eCollection 2021.
Acute kidney injury (AKI) is a common and serious complication faced by children following ventricular septal defect (VSD) surgery with cardiopulmonary bypass (CPB). The objective of this study was to explore potential predictors inherent to AKI. VSD infants who were scheduled for elective cardiac surgery with CPB from 2017 to 2020 were enrolled in this study. Based on the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) criteria, patients were divided into AKI and non-AKI groups. Univariate and multivariate logistic regression analyses were carried out in order to evaluate potential risk factors for AKI. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive probabilities of risk factors for AKI. Of all the 338 enrolled VSD infants, 49 manifested AKI with an incidence of 14.5% (49/338). The ROC curve indicated that albumin-to-fibrinogen ratio (AFR) during CPB was a significant predictor of AKI [area under the curve (AUC), 0.711; < 0.001]. Based on the univariate and multivariate logistic analyses, AFR during CPB [odds ratio (OR), 1.89; 95% confidence interval (CI), 1.22-2.76, = 0.011] was the only independent risk factor for AKI. This study demonstrated that a low AFR (<9.35) during CPB was an independent risk factor for AKI in VSD infants following cardiac surgery with CPB.
急性肾损伤（AKI）是室间隔缺损（VSD）患儿在体外循环（CPB）下进行心脏手术后面临的常见且严重的并发症。本研究的目的是探索AKI内在的潜在预测因素。本研究纳入了2017年至2020年计划接受择期CPB心脏手术的VSD婴儿。根据儿童风险、损伤、衰竭、丧失、终末期肾病（pRIFLE）标准，将患者分为AKI组和非AKI组。进行单因素和多因素逻辑回归分析以评估AKI的潜在危险因素。生成受试者工作特征（ROC）曲线以评估AKI危险因素的预测概率。在所有338例纳入研究的VSD婴儿中，49例出现AKI，发生率为14.5%（49/338）。ROC曲线表明，CPB期间白蛋白与纤维蛋白原比值（AFR）是AKI的显著预测因素[曲线下面积（AUC），0.711；<0.001]。基于单因素和多因素逻辑分析，CPB期间的AFR[比值比（OR），1.89；95%置信区间（CI），1.22 - 2.76，=0.011]是AKI的唯一独立危险因素。本研究表明CPB期间低AFR（<9.35）是VSD婴儿在CPB心脏手术后发生AKI的独立危险因素。
