Department of Cardiovascular Perfusion, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
J Extra Corpor Technol. 2023 Sep;55(3):112-120. doi: 10.1051/ject/2023029. Epub 2023 Sep 8.
Acute kidney injury after pediatric cardiac surgery is a common complication with few established modifiable risk factors. We sought to characterize whether indexed oxygen delivery during cardiopulmonary bypass was associated with postoperative acute kidney injury in a large pediatric cohort.
This was a retrospective analysis of patients under 1 year old undergoing cardiac surgery with cardiopulmonary bypass between January 1, 2013, and January 1, 2020. Receiver operating characteristic curves across values ranging from 260 to 400 mL/min/m were used to identify the indexed oxygen delivery most significantly associated with acute kidney injury risk.
We included 980 patients with acute kidney injury occurring in 212 (21.2%). After adjusting for covariates associated with acute kidney injury, an indexed oxygen delivery threshold of 340 mL/min/m predicted acute kidney injury in STAT 4 and 5 neonates (area under the curve = 0.66, 95% CI = 0.60 - 0.72, sensitivity = 56.1%, specificity = 69.4%). An indexed oxygen delivery threshold of 400 mL/min/m predicted acute kidney injury in STAT 1-3 infants (area under the curve = 0.65, 95% CI = 0.58 - 0.72, sensitivity = 52.6%, specificity = 74.6%).
Indexed oxygen delivery during cardiopulmonary bypass is a modifiable variable independently associated with postoperative acute kidney injury in specific pediatric populations. Strategies aimed at maintaining oxygen delivery greater than 340 mL/min/m in complex neonates and greater than 400 mL/min/m in infants may reduce the occurrence of postoperative acute kidney injury in the pediatric population.
小儿心脏手术后急性肾损伤是一种常见的并发症，仅有少数明确的可改变的危险因素。我们试图描述体外循环期间的氧输送指数与大型儿科队列术后急性肾损伤之间的关系。
这是一项对 2013 年 1 月 1 日至 2020 年 1 月 1 日期间接受体外循环心脏手术的 1 岁以下患者进行的回顾性分析。使用从 260 到 400 毫升/分钟/平方米范围的接收器工作特征曲线来识别与急性肾损伤风险最显著相关的氧输送指数。
我们纳入了 980 例发生急性肾损伤的患者，其中 212 例（21.2%）。在调整了与急性肾损伤相关的协变量后，氧输送指数阈值为 340 毫升/分钟/平方米可预测 STAT4 和 5 新生儿的急性肾损伤（曲线下面积=0.66，95%置信区间=0.60-0.72，敏感性=56.1%，特异性=69.4%）。氧输送指数阈值为 400 毫升/分钟/平方米可预测 STAT1-3 婴儿的急性肾损伤（曲线下面积=0.65，95%置信区间=0.58-0.72，敏感性=52.6%，特异性=74.6%）。
体外循环期间的氧输送指数是与特定儿科人群术后急性肾损伤独立相关的可改变变量。在复杂的新生儿中维持氧输送大于 340 毫升/分钟/平方米，在婴儿中维持氧输送大于 400 毫升/分钟/平方米的策略可能会降低儿科人群术后急性肾损伤的发生。
