Sun Yuhan, Zeng Xian, Shi Shanshan, Shi Zhuo, Huang Ting, Fan Yong, Feng Yuqing, Lu Xudong, Duan Huilong, Fan Xiangming, Shu Qiang, Li Haomin
Clinical Data Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 310052 Hangzhou, Zhejiang, China.
The College of Biomedical Engineering and Instrument Science, Zhejiang University, 310027 Hangzhou, Zhejiang, China.
Rev Cardiovasc Med. 2023 Nov 24;24(11):331. doi: 10.31083/j.rcm2411331. eCollection 2023 Nov.
Acute kidney injury (AKI) is a common complication after pediatric cardiac surgery. And autologous blood transfusion (ABT) is an important predictor of postoperative AKI. Unlike previous studies, which mainly focused on the correlation between ABT and AKI, the current study focuses heavily on the causal relationship between them, thus providing guidance for the treatment of patients during hospitalization to reduce the occurrence of AKI.
A retrospective cohort of 3386 patients extracted from the Pediatric Intensive Care database was used for statistical analysis, multifactorial analysis, and causal inference. Characteristics that were correlated with ABT and AKI were categorized as confounders, instrumental variables, and effect modifiers, and were entered into the DoWhy causal inference model to determine causality. The calculated average treatment effect (ATE) was compared with the results of the multifactorial analysis.
The adjusted odds ratio (OR) for ABT volume was obtained by multifactorial analysis as 0.964. The DoWhy model refute test was able to indicate a causal relationship between ABT and AKI. Any ABT reduces AKI about 15.3%-18.8% by different estimation methods. The ATE regarding the amount of ABT was -0.0088, suggesting that every 1 mL/kg of ABT reduced the risk of AKI by 0.88%.
Intraoperative transfusion of autologous blood can have a protective effect against postoperative AKI.
急性肾损伤（AKI）是小儿心脏手术后常见的并发症。自体输血（ABT）是术后AKI的重要预测指标。与以往主要关注ABT与AKI之间相关性的研究不同，本研究重点关注两者之间的因果关系，从而为住院期间患者的治疗提供指导，以减少AKI的发生。
从儿科重症监护数据库中提取3386例患者的回顾性队列进行统计分析、多因素分析和因果推断。将与ABT和AKI相关的特征分类为混杂因素、工具变量和效应修饰因素，并纳入DoWhy因果推断模型以确定因果关系。将计算出的平均治疗效果（ATE）与多因素分析结果进行比较。
多因素分析得出ABT量的调整比值比（OR）为0.964。DoWhy模型反驳检验能够表明ABT与AKI之间存在因果关系。通过不同的估计方法，任何ABT均可使AKI降低约15.3%-18.8%。ABT量的ATE为-0.0088，表明每1 mL/kg的ABT可使AKI风险降低0.88%。
术中输注自体血对术后AKI具有保护作用。
