Department of Critical Care Medicine, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.
Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan.
Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231184465. doi: 10.1177/10760296231184465.
Vascular endothelial damage may activate hypercoagulation and contribute to the development of acute kidney injury (AKI). This study aimed to investigate whether early alteration in coagulation was associated with AKI onset following surgeries involving cardiopulmonary bypass (CPB) in children. This single-center retrospective cohort study included 154 infants and toddlers who underwent cardiovascular surgery with CPB. At admission to the pediatric intensive care unit, the absolute thrombin-antithrombin complex (TAT) level in each patient was measured. Moreover, the presence or absence of AKI onset in the early postoperative period was observed. Of the total participants, 55 (35%) developed AKI. A comparison within the toddler group based on the TAT cut-off value showed that both univariate and multivariable associations were found between increased absolute TAT level and AKI onset (odds ratio, 4.70; 95% confidence interval [1.20-17.90]; = .023). The increase in absolute TAT level in toddlers during the early postoperative period following CPB was associated with AKI onset. However, a further prospective multicenter study with a larger sample size is required for validating these findings.
血管内皮损伤可能激活高凝状态，导致急性肾损伤（AKI）的发生。本研究旨在探讨体外循环（CPB）心脏手术后，凝血功能早期变化是否与儿童 AKI 的发生有关。本单中心回顾性队列研究纳入了 154 名接受 CPB 心血管手术的婴幼儿。在入住儿科重症监护病房时，测量了每位患者的绝对凝血酶-抗凝血酶复合物（TAT）水平。此外，观察了术后早期是否发生 AKI。在总参与者中，有 55 名（35%）发生了 AKI。基于 TAT 截断值对婴幼儿组进行的比较表明，绝对 TAT 水平升高与 AKI 发生之间存在单变量和多变量关联（比值比，4.70；95%置信区间[1.20-17.90]； = .023）。CPB 后婴幼儿早期术后绝对 TAT 水平升高与 AKI 发生相关。然而，需要进一步进行具有更大样本量的前瞻性多中心研究来验证这些发现。
