Background: We hypothesized that administration of Treprostinil after high-risk total cavo-pulmonary connection (TCPC) procedure may be benefit for hemodynamics and post-operative recovery. Methods: From 2015 to 2022, among patients who underwent TCPC procedure and received Treprostinil therapy in our single center, high-risk patients (mean pulmonary arterial pressure= 15mmHg) were retrospectively analyzed. Patients were separated into satisfactory recovery group and delayed recovery group based on whether the post-operative length of stay was more than 30 days. The peri-operative date of the two groups were investigated to find possible indicators to improve the post-operative recovery as the primary outcome. The hemodynamics data after 24 hours maintaining dose of Treprostinil were investigated as the second outcome. Results: Among 371 TCPC patients, 24 patients were included in our study. There were 9 patients in satisfactory recovery group and 15 patients in delayed recovery group. The statistical difference existed in the maintaining dose of Treprostinil (p=0.005), pleural effusion volume (p=0.001) and renal replacement therapy (p=0.022). Through multivariable analysis, only Treprostinil was of statistical difference (p=0.027). The ROC curve shown that maintaining dose>19.5 ng/kg/min was the cut off point, with the area under curve 0.852, sensitivity 0.89, specificity 0.8. During the observation of hemodynamic data, the mean pulmonary artery pressure decreased from 14±4 to 12±3 mmHg (p<0.001) with no severe complications. Conclusion: In patients after TCPC procedure, the Treprostinil therapy can decrease mean pulmonary artery pressure without severe complication. A maintaining dose of Treprostinil >19.5 ng/kg/min is benefit to shorten the post-operative length of hospital stay.
BackgroundMultiple biomarkers have been identified by previous studies to diagnose acute kidney injury (AKI). Moreover, combination of biomarkers with conventional criteria to define AKI substages so that we can identify high-risk patients and improve diagnostic accuracy were recommended. Our study aimed to explore the incidence of AKI substages defined by serum cystatin C (CysC), determine whether AKI substages were associated with worse outcomes.MethodsWe prospectively included 2519 pediatric patients (<16yrs) undergoing cardiac surgery with cardiopulmonary bypass in our cohort between March 2022 to February 2023 in Fuwai Hospital. Demographic and clinical variables we collected. To define AKI substages, Kidney Disease: Improving Global Outcomes AKI definition (based on SCr or CysC) was used. The association between AKI exposure and outcomes including length of intensive care unit stay, duration of mechanical ventilation, length of hospital stay and 30-day mortality was assessed. In addition, we determined areas under the receiver operating characteristic curve and cutoff value of CysC at different timepoints to predict AKI.Results507 (20.8%) patients developed SCr-AKI, with 337 (13.8%) in stage 1, 77(3.2%) in stage 2 and 93 (3.8%) in stage 3 respectively. Of the 1925 patients without SCr-AKI, 256 (14.3%) met the definition of sub-AKI. Of the 507 patients with SCr-AKI, 281 (55.4%) patients were defined as AKI substage A, while others (226, 44.6%) were defined as AKI substage B. After adjusting for BSA, neonates, STAT mortality score≥4, previous sternotomy and CPB time>120min, the postoperative LOIS, LOHS and DMV were prolonged with increasing hospitalization expense (P<0.05) in patients with SCr-AKI and/or CysC-AKI. Meanwhile, only the hospitalization expense was increased in patients with SCr-AKI(P<0.05) after the same adjustment. The AUC was 0.691, 0.720 and 0.817 respectively in ROC curves of preoperative, relative variation of or postoperative serum CysC. Delong’ test showed that postoperative serum CysC might have better diagnostic performance characteristic than preoperative or relative variation of CysC (P<0.001), with a cutoff point at 1.29 mg/dL (Specificity, 0.77; Sensitivity, 0.71)ConclusionsOur analysis indicates defining AKI with both CysC and SCr might more significantly affecting clinical outcome associations in pediatric patients undergoing cardiac surgery. Moreover, the serum CysC cutoff of 1.29mg/dL postoperatively is a valuable threshold for AKI risk assessment to define AKI subtypes.
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