Kourelis Georgios, Kanakis Meletios, Samanidis George, Tzannis Kimon, Bobos Dimitrios, Kousi Theofili, Apostolopoulou Sotiria, Kakava Felicia, Kyriakoulis Konstantinos, Bounta Stavroula, Rammos Spyridon, Papagiannis John, Giannopoulos Nickolas, Orfanos Stylianos E, Dimopoulos George
Pediatric Cardiac and Adult Congenital Heart Disease Intensive Care Unit, Onassis Cardiac Surgery Center, Andrea Syggrou 356 Av., 17674 Kallithea, Greece.
Paediatric Cardiac and Adult Congenital Heart Disease Surgical Department, Onassis Cardiac Surgery Center, Andrea Syggrou 356 Av., 17674 Kallithea, Greece.
Diagnostics (Basel). 2022 Oct 2;12(10):2397. doi: 10.3390/diagnostics12102397.
Acute Kidney Injury (AKI) commonly complicates cardiac surgery in children with congenital heart disease (CHD). In this study we assessed incidence, risk factors, and outcomes of postoperative AKI, while testing the hypothesis that, depending on the underlying diagnosis, there would be significant differences in AKI incidence among different diagnostic groups. We conducted an observational cohort study of children with CHD undergoing cardiac surgery in a single tertiary center between January 2019 and August 2021 (n = 362). Kidney Disease Improving Global Outcome (KDIGO) criteria were used to determine the incidence of postoperative AKI. Diagnosis was incorporated into multivariate models using an anatomic-based CHD classification system. Overall survival was estimated using Kaplan−Meier curves. Log-rank test and adjusted Cox proportional hazard modelling were used to test for differences in survival distributions and determine AKI effect on survival function, respectively. AKI occurred in 70 (19.3%), with 21.4% in-hospital mortality for AKI group. Younger age, lower weight, longer cardiopulmonary bypass time, preoperative mechanical ventilation and diagnostic category were associated with postoperative AKI. Resolution rate was 92.7% prior to hospital discharge for survivors. AKI was associated with longer duration of mechanical ventilation, ICU and hospital length of stay. AKI patients had significantly higher probability of all-cause mortality postoperatively when compared to the non-AKI group (log-rank test, p < 0.001). Adjusted hazard ratio for AKI versus non-AKI group was 11.08 (95% CI 2.45−50.01; p = 0.002). Diagnostic category was associated with cardiac surgery-related AKI in children with CHD, a finding supporting the development of lesion specific models for risk stratification. Postoperative AKI had detrimental impact on clinical outcomes and was associated with decreased survival to hospital discharge.
急性肾损伤（AKI）在患有先天性心脏病（CHD）的儿童心脏手术中常并发。在本研究中，我们评估了术后AKI的发生率、危险因素和结局，同时检验了这样一个假设，即根据潜在诊断，不同诊断组之间的AKI发生率会有显著差异。我们在2019年1月至2021年8月期间，在一个单一的三级中心对接受心脏手术的CHD儿童进行了一项观察性队列研究（n = 362）。采用改善全球肾脏病预后组织（KDIGO）标准来确定术后AKI的发生率。使用基于解剖学的CHD分类系统将诊断纳入多变量模型。使用Kaplan-Meier曲线估计总体生存率。分别使用对数秩检验和调整后的Cox比例风险模型来检验生存分布的差异并确定AKI对生存功能的影响。70例（19.3%）发生了AKI，AKI组的院内死亡率为21.4%。年龄较小、体重较低、体外循环时间较长、术前机械通气和诊断类别与术后AKI相关。幸存者出院前的缓解率为92.7%。AKI与机械通气时间延长、ICU和住院时间延长有关。与非AKI组相比，AKI患者术后全因死亡的概率显著更高（对数秩检验，p < 0.001）。AKI组与非AKI组的调整后风险比为11.08（95%CI 2.45 - ５０.０１；p = 0.002）。诊断类别与CHD儿童心脏手术相关的AKI有关，这一发现支持开发针对病变的风险分层模型。术后AKI对临床结局有不利影响，并与出院生存率降低有关。
