Aşır Ayşegül, Aldudak Bedri, Matur Okur Nilüfer
Clinics of Pediatrics, Gazi Yaşargil Training and Research Hospital, 21090 Diyarbakır, Turkey.
Clinics of Pediatric Cardiology, Gazi Yaşargil Training and Research Hospital, 21090 Diyarbakır, Turkey.
Life (Basel). 2024 Dec 18;14(12):1679. doi: 10.3390/life14121679.
Postoperative fluid overload is associated with increased mortality and morbidity in infants with congenital heart disease (CHD). Loop diuretics, such as furosemide, are commonly used to prevent fluid overload in the postoperative period. This study aimed to investigate the effect of postoperative albumin levels on the efficacy of furosemide after surgery in infants with CHD. From 1 January 2017 to 31 December 2022, postoperative albumin levels, total furosemide doses, and three-day postoperative diuresis levels were retrospectively analyzed in 186 patients aged 0-1 years who underwent cardiopulmonary bypass at the Pediatric Intensive Care Unit, Diyarbakır Gazi Yaşargil Training and Research Hospital. Demographic and clinical parameters, along with urine output in the first 6 h, first 24 h, 24-48 h, and 48-72 h postoperatively, were recorded. Patients were divided into two groups based on their albumin levels: normal albumin (≥30 g/dL) and hypoalbuminemia (<30 g/dL). A common protein interaction network for albumin and furosemide was constructed using Cytoscape software (version 3.10.2). Of the 186 patients, 79 (42.5%) were male and 107 (57.5%) were female, with a median age of 97.5 days (range 1-360 days). Furosemide doses were higher in hypoalbuminemic patients on postoperative days 1 and 2 compared to normoalbuminemic patients. On postoperative day 1, hypoalbuminemia was more prevalent in patients with oliguria, whereas normoalbuminemia was significantly higher in patients with normouria and polyuria. Furosemide doses were significantly higher in patients with oliguria than in those with normouria in the first 6 h and lower in patients with polyuria compared to those with normouria. A positive correlation was observed between albumin levels and furosemide efficacy on postoperative day 2. Additionally, a positive correlation existed between albumin levels on postoperative day 1 and urine output in the first 6 and 24 h postoperatively. Furosemide efficacy and urine output were positively correlated in the postoperative period. Mortality risk was significantly higher in hypoalbuminemic patients on postoperative days 1 and 2, as well as in patients with oliguria in the first 6 and 24 h postoperatively. Network analysis revealed that albumin was directly involved in furosemide's target network, along with six other proteins within the common interaction network. Diuresis levels were significantly lower in hypoalbuminemic patients. We suggest that the effectiveness of furosemide is reduced because it cannot bind to albumin at sufficient levels. The effective management of albumin levels may enhance furosemide efficacy and improve postoperative outcomes in infants with CHD.
术后液体超负荷与先天性心脏病（CHD）患儿的死亡率和发病率增加相关。袢利尿剂，如呋塞米，常用于预防术后液体超负荷。本研究旨在探讨术后白蛋白水平对CHD患儿术后呋塞米疗效的影响。对2017年1月1日至2022年12月31日在迪亚巴克尔加齐·亚萨尔吉尔培训与研究医院儿科重症监护病房接受体外循环的186例0至1岁患儿的术后白蛋白水平、呋塞米总剂量和术后三天的利尿水平进行了回顾性分析。记录了人口统计学和临床参数，以及术后前6小时、前24小时、24至48小时和48至72小时的尿量。根据白蛋白水平将患者分为两组：正常白蛋白组（≥30 g/dL）和低白蛋白血症组（<30 g/dL）。使用Cytoscape软件（3.10.2版）构建了白蛋白和呋塞米的常见蛋白质相互作用网络。186例患者中，79例（42.5%）为男性，107例（57.5%）为女性，中位年龄为97.5天（范围1至360天）。与正常白蛋白血症患者相比，低白蛋白血症患者术后第1天和第2天的呋塞米剂量更高。术后第1天，少尿患者中低白蛋白血症更为普遍，而正常尿量和多尿患者中正常白蛋白血症显著更高。少尿患者在前6小时的呋塞米剂量显著高于正常尿量患者，多尿患者的呋塞米剂量低于正常尿量患者。术后第2天白蛋白水平与呋塞米疗效呈正相关。此外，术后第1天的白蛋白水平与术后前6小时和24小时的尿量呈正相关。术后呋塞米疗效与尿量呈正相关。低白蛋白血症患者术后第1天和第2天的死亡风险显著更高，术后前6小时和24小时少尿患者的死亡风险也显著更高。网络分析显示，白蛋白直接参与呋塞米的靶网络，以及常见相互作用网络中的其他六种蛋白质。低白蛋白血症患者的利尿水平显著较低。我们认为，呋塞米的有效性降低是因为它不能与足够水平的白蛋白结合。有效管理白蛋白水平可能会提高呋塞米的疗效，并改善CHD患儿的术后结局。
