Pierick Alyson R, Luckritz Kera E, Huebschman Ashley, Duimstra Ashley, Yu Sunkyung, Sznycer-Taub Nathaniel
Divison of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
Pediatr Cardiol. 2025 Jun 28. doi: 10.1007/s00246-025-03929-y.
Acute kidney injury (AKI) is a common complication in infants after cardiac surgery. Prior studies have demonstrated that urine output response to bolus dose furosemide correlates with AKI development but have excluded infants receiving a furosemide infusion. We sought to determine if urine output in response to a furosemide infusion in infants after cardiac surgery predicts AKI development. Single center retrospective cohort study of infants post cardiac surgery requiring cardiopulmonary bypass and received a post-operative furosemide infusion. A furosemide response score (FRS) (urine output [mL]/furosemide delivered [mg/kg]) was calculated. The FRS was used to determine optimal cut-offs to predict clinically significant AKI (CS-AKI), defined as stage 2 or 3 AKI. A furosemide infusion was started at a median of 9.4 h (interquartile range 6.6-13.6 h) after intensive care unit (ICU) admission in 155 infants. The post-operative incidence of AKI was 76.8%, with 44.5% having CS-AKI. The optimal FRS cut-off to correlate with AKI was 11.3 mL/mg/kg at 4 h (area under the curve [AUC] = 0.75), 25.5 mL/mg/kg at 10 h (AUC = 0.70), and 53.3 mL/mg/kg at 24 h (AUC = 0.70) post-infusion initiation, and independently associated with the development of AKI. Lower FRS also correlated with increased mechanical ventilation days and ICU/hospital length of stay. Urine output in response to a furosemide infusion in infants following cardiac surgery is associated with post-operative CS-AKI. The FRS can be used to predict AKI and potentially improve hemodynamics while minimizing risks.
急性肾损伤（AKI）是心脏手术后婴儿常见的并发症。先前的研究表明，静脉推注速尿后的尿量反应与AKI的发生相关，但排除了接受速尿输注的婴儿。我们试图确定心脏手术后婴儿接受速尿输注后的尿量是否能预测AKI的发生。对需要体外循环且术后接受速尿输注的心脏手术后婴儿进行单中心回顾性队列研究。计算速尿反应评分（FRS）（尿量[mL]/给予的速尿[mg/kg]）。FRS用于确定预测临床显著性AKI（CS-AKI，定义为2期或3期AKI）的最佳临界值。155例婴儿在重症监护病房（ICU）入院后中位数9.4小时（四分位间距6.6 - 13.6小时）开始速尿输注。术后AKI的发生率为76.8%，其中44.5%患有CS-AKI。与AKI相关的最佳FRS临界值在输注开始后4小时为11.3 mL/mg/kg（曲线下面积[AUC]=0.75），10小时为25.5 mL/mg/kg（AUC = 0.70），24小时为53.3 mL/mg/kg（AUC = 0.70），且与AKI的发生独立相关。较低的FRS也与机械通气天数增加及ICU/住院时间延长相关。心脏手术后婴儿接受速尿输注后的尿量与术后CS-AKI相关。FRS可用于预测AKI，并可能在将风险降至最低的同时改善血流动力学。
