Division of Pediatric Cardiology Department of Pediatrics Faculty of Medicine University of British Columbia Vancouver Canada.
Department of Pediatrics Faculty of Medicine University of British Columbia Vancouver Canada.
J Am Heart Assoc. 2021 Oct 19;10(20):e020519. doi: 10.1161/JAHA.120.020519. Epub 2021 Oct 8.
Background Diuretics are used to manage congestive heart failure in infants with congenital heart disease. Adult data indicate that preoperative diuretic use increases the risk of cardiac surgery associated acute kidney injury (CS-AKI). We have sought to understand if preoperative diuretics in infants increases the risk of CS-AKI. Methods and Results This is a single-center retrospective study of infants (1-12 months) who had CS requiring cardiopulmonary bypass between 2013 and 2018. The diagnosis and severity of CS-AKI was defined according to the Kidney Disease Improving Global Outcomes guidelines. Three hundred patients were included (mean 6 months, SD 2.4, range 1.2-12.9 months). A total of 149 (49.7%) patients were diagnosed with CS-AKI (stage 1: 80 [54%], stage 2: 57 [38%], stage 3: 12 [8%]). Logistic regression analysis showed preoperative diuretics were not associated with CS-AKI (odds ratio [OR], 0.79; 95% CI, 0.43-1.44; =0.45). A diagnosis of tetralogy of Fallot was an independent risk factor for CS-AKI (OR, 3.49; 95% CI, 1.33-9.1, =0.01). A diagnosis of tetralogy of Fallot (OR, 3.6; 95% CI, 1.28-10.22; =0.02) and longer cardiopulmonary bypass (OR, 1.01; 95% CI, 1.0-1.02; =0.04) time are risk factors for moderate to severe CS-AKI. Conclusions Preoperative diuretic use does not contribute to the risk of CS-AKI in infants early after surgery. A diagnosis of tetralogy of Fallot was the only risk factor for CS-AKI identified using multivariate analysis in our cohort. Furthermore, a diagnosis of tetralogy of Fallot and longer cardiopulmonary bypass time are risk factors for moderate to severe CS-AKI.
利尿剂用于治疗患有先天性心脏病的充血性心力衰竭婴儿。成人数据表明，术前使用利尿剂会增加心脏手术相关急性肾损伤（CS-AKI）的风险。我们试图了解婴儿术前使用利尿剂是否会增加 CS-AKI 的风险。
这是一项对 2013 年至 2018 年间接受体外循环心脏手术的 1-12 个月婴儿的单中心回顾性研究。根据肾脏疾病改善全球结局指南定义 CS-AKI 的诊断和严重程度。共纳入 300 例患者（平均 6 个月，标准差 2.4，范围 1.2-12.9 个月）。共有 149 例（49.7%）患者诊断为 CS-AKI（第 1 期：80 例[54%]，第 2 期：57 例[38%]，第 3 期：12 例[8%]）。Logistic 回归分析显示，术前利尿剂的使用与 CS-AKI 无关（比值比[OR]，0.79；95%置信区间，0.43-1.44；=0.45）。法洛四联症的诊断是 CS-AKI 的独立危险因素（OR，3.49；95%置信区间，1.33-9.1，=0.01）。法洛四联症的诊断（OR，3.6；95%置信区间，1.28-10.22；=0.02）和更长的体外循环时间（OR，1.01；95%置信区间，1.0-1.02；=0.04）是中重度 CS-AKI 的危险因素。
术前利尿剂的使用不会增加婴儿手术后早期 CS-AKI 的风险。多变量分析显示，法洛四联症的诊断是我们队列中 CS-AKI 的唯一危险因素。此外，法洛四联症的诊断和更长的体外循环时间是中重度 CS-AKI 的危险因素。
