Dae-Kee Choi1, Wook-Jong Kim1, Ji-Hyun Chin1, Eun-Ho Lee1, Kyung Don Hahm1, Ji Yeon Sim1, In Cheol Choi2. 1. Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 2. Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: icchoi@amc.seoul.kr.
Abstract
OBJECTIVE: To evaluate the usefulness of renal regional oxygen saturation (renal rSO2) in predicting the risk of acute kidney injury (AKI) after cardiac surgery. DESIGN: A prospective observational study. SETTING: Tertiary care university hospital. PARTICIPANTS: One hundred patients undergoing cardiac surgery. INTERVENTIONS: Renal rSO2 was monitored continuously by near-infrared spectroscopy (NIRS) throughout the anesthetic period. MEASUREMENTS AND MAIN RESULTS: Postoperative AKI was defined using the Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria. Of 95 patients who were included in the final analysis, 34 patients developed AKI after surgery. Recorded renal rSO2 data were used to calculate the total duration of the time when renal rSO2 was below the threshold values of 70%, 65%, 60%, 55%, and 50%. The total periods when the renal rSO2 level was below each of the threshold values were significantly longer in patients with AKI than in those without AKI (p = 0.001 or p<0.001). Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive power of renal rSO2 for AKI. The ROC curve analysis showed that renal rSO2 could predict the risk of AKI with statistical significance and that a renal rSO2<55% had the best performance (area under the curve-ROC, 0.777; 95% CI, 0.669-0.885; p<0.001). Multivariate logistic regression analysis revealed that AKI significantly correlated with the duration of renal rSO2<55% (p = 0.002) and logistic EuroSCORE (p = 0.007). CONCLUSIONS: Intraoperative renal regional oxygen desaturation can be a good predictor of AKI in adult patients undergoing cardiac surgery.
OBJECTIVE: To evaluate the usefulness of renal regional oxygen saturation (renal rSO2) in predicting the risk of acute kidney injury (AKI) after cardiac surgery. DESIGN: A prospective observational study. SETTING: Tertiary care university hospital. PARTICIPANTS: One hundred patients undergoing cardiac surgery. INTERVENTIONS: Renal rSO2 was monitored continuously by near-infrared spectroscopy (NIRS) throughout the anesthetic period. MEASUREMENTS AND MAIN RESULTS: Postoperative AKI was defined using the Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria. Of 95 patients who were included in the final analysis, 34 patients developed AKI after surgery. Recorded renal rSO2 data were used to calculate the total duration of the time when renal rSO2 was below the threshold values of 70%, 65%, 60%, 55%, and 50%. The total periods when the renal rSO2 level was below each of the threshold values were significantly longer in patients with AKI than in those without AKI (p = 0.001 or p<0.001). Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive power of renal rSO2 for AKI. The ROC curve analysis showed that renal rSO2 could predict the risk of AKI with statistical significance and that a renal rSO2<55% had the best performance (area under the curve-ROC, 0.777; 95% CI, 0.669-0.885; p<0.001). Multivariate logistic regression analysis revealed that AKI significantly correlated with the duration of renal rSO2<55% (p = 0.002) and logistic EuroSCORE (p = 0.007). CONCLUSIONS: Intraoperative renal regional oxygen desaturation can be a good predictor of AKI in adult patients undergoing cardiac surgery.
Authors: Roger G Evans; Naoya Iguchi; Andrew D Cochrane; Bruno Marino; Sally G Hood; Rinaldo Bellomo; Peter R McCall; Clive N May; Yugeesh R Lankadeva Journal: Am J Physiol Regul Integr Comp Physiol Date: 2019-12-11 Impact factor: 3.619