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诺伍德手术后的液体超负荷与急性肾损伤:常规临床指标的相关性及特征

Fluid Overload and AKI After the Norwood Operation: The Correlation and Characterization of Routine Clinical Markers.

作者信息

Weld Julia, Kim Erin, Chandra Priya, Savorgnan Fabio, Acosta Sebastian, Flores Saul, Loomba Rohit S

机构信息

Division of Cardiology, Department of Pediatrics, Advocate Children's Hospital, Oak Lawn, IL, USA.

Division of Nephrology, Department of Pediatrics, Advocate Children's Hospital, Oak Lawn, IL, USA.

出版信息

Pediatr Cardiol. 2024 Oct;45(7):1440-1447. doi: 10.1007/s00246-023-03167-0. Epub 2023 May 2.

Abstract

The purpose of this study was to determine the correlation of different methods of assessing fluid overload and determine which metrics are associated with development of acute kidney injury (AKI) in the period immediately following Norwood palliation. This was a retrospective single-center study of Norwood patients from January 2011 through January 2021. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO). Patients were separated into two groups: those with AKI and those without. A logistic regression analysis was conducted with AKI at any point in the study period as the dependent variable and clinical and laboratory data as independent variables. Analysis was conducted as a stepwise regression. The coefficients from the logistic regression were then used to develop a cumulative AKI risk score. Spearman correlations were conducted to analyze the correlation of fluid markers. 116 patients were included, and 49 (42.4%) developed AKI. The duration of open chest, duration of mechanical ventilation, need for dialysis, need for extracorporeal membrane oxygenation, and inpatient mortality were associated with AKI (p ≤ 0.05). Stepwise logistic regression demonstrated the following significant independent associations AKI: age at Norwood in days (p < 0.01), blood urea nitrogen (p < 0.01), central venous pressure (p = 0.04), and renal oxygen extraction ratio (p < 0.01). The area under the receiver operating characteristic curve for the logistic regression was 0.74. The fluid markers had weak R-value. Urea, central venous pressure, and renal oxygen extraction ratio are associated with AKI after the Norwood operation. Common clinical metrics used to assess fluid overload are poorly correlated with each other for postoperative Norwood patients.

摘要

本研究的目的是确定评估液体超负荷的不同方法之间的相关性,并确定哪些指标与诺伍德姑息治疗后立即发生的急性肾损伤(AKI)相关。这是一项对2011年1月至2021年1月期间诺伍德患者的回顾性单中心研究。AKI采用改善全球肾脏病预后组织(KDIGO)的定义。患者分为两组:发生AKI的患者和未发生AKI的患者。以研究期间任何时间点的AKI作为因变量,临床和实验室数据作为自变量进行逻辑回归分析。分析采用逐步回归进行。然后,将逻辑回归的系数用于制定累积AKI风险评分。采用斯皮尔曼相关性分析来分析液体标志物之间的相关性。纳入116例患者,其中49例(42.4%)发生AKI。开胸时间、机械通气时间、透析需求、体外膜肺氧合需求和住院死亡率与AKI相关(p≤0.05)。逐步逻辑回归显示AKI有以下显著独立关联因素:诺伍德手术时的年龄(以天数计,p<0.01)、血尿素氮(p<0.01)、中心静脉压(p=0.04)和肾氧摄取率(p<0.01)。逻辑回归的受试者工作特征曲线下面积为0.74。液体标志物的R值较弱。尿素、中心静脉压和肾氧摄取率与诺伍德手术后的AKI相关。用于评估液体超负荷的常见临床指标在诺伍德术后患者中相互之间相关性较差。

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