Bárbara Cardoso1, Sérgio Laranjo2, Inês Gomes2, Isabel Freitas2, Conceição Trigo2, Isabel Fragata3, José Fragata4, Fátima Pinto2. 1. Serviço de Cardiologia Pediátrica, Hospital Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa, Portugal. Electronic address: barbaracardoso.ba@gmail.com. 2. Serviço de Cardiologia Pediátrica, Hospital Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa, Portugal. 3. Serviço de Anestesiologia, Hospital de Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa, Portugal. 4. Serviço de Cirurgia Cardiotorácica, Hospital de Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
Abstract
OBJECTIVES: To characterize the epidemiology and risk factors for acute kidney injury (AKI) after pediatric cardiac surgery in our center, to determine its association with poor short-term outcomes, and to develop a logistic regression model that will predict the risk of AKI for the study population. METHODS: This single-center, retrospective study included consecutive pediatric patients with congenital heart disease who underwent cardiac surgery between January 2010 and December 2012. Exclusion criteria were a history of renal disease, dialysis or renal transplantation. RESULTS: Of the 325 patients included, median age three years (1 day-18 years), AKI occurred in 40 (12.3%) on the first postoperative day. Overall mortality was 13 (4%), nine of whom were in the AKI group. AKI was significantly associated with length of intensive care unit stay, length of mechanical ventilation and in-hospital death (p<0.01). Patients' age and postoperative serum creatinine, blood urea nitrogen and lactate levels were included in the logistic regression model as predictor variables. The model accurately predicted AKI in this population, with a maximum combined sensitivity of 82.1% and specificity of 75.4%. CONCLUSIONS: AKI is common and is associated with poor short-term outcomes in this setting. Younger age and higher postoperative serum creatinine, blood urea nitrogen and lactate levels were powerful predictors of renal injury in this population. The proposed model could be a useful tool for risk stratification of these patients.
OBJECTIVES: To characterize the epidemiology and risk factors for acute kidney injury (AKI) after pediatric cardiac surgery in our center, to determine its association with poor short-term outcomes, and to develop a logistic regression model that will predict the risk of AKI for the study population. METHODS: This single-center, retrospective study included consecutive pediatric patients with congenital heart disease who underwent cardiac surgery between January 2010 and December 2012. Exclusion criteria were a history of renal disease, dialysis or renal transplantation. RESULTS: Of the 325 patients included, median age three years (1 day-18 years), AKI occurred in 40 (12.3%) on the first postoperative day. Overall mortality was 13 (4%), nine of whom were in the AKI group. AKI was significantly associated with length of intensive care unit stay, length of mechanical ventilation and in-hospital death (p<0.01). Patients' age and postoperative serum creatinine, blood ureanitrogen and lactate levels were included in the logistic regression model as predictor variables. The model accurately predicted AKI in this population, with a maximum combined sensitivity of 82.1% and specificity of 75.4%. CONCLUSIONS: AKI is common and is associated with poor short-term outcomes in this setting. Younger age and higher postoperative serum creatinine, blood ureanitrogen and lactate levels were powerful predictors of renal injury in this population. The proposed model could be a useful tool for risk stratification of these patients.
Authors: Shahram Amini; Hasan Abbaspour; Negar Morovatdar; Hojat Naghavi Robabi; Ghasem Soltani; Mohammad Abbasi Tashnizi Journal: Indian J Crit Care Med Date: 2017-12