Development of a risk prediction model for acute kidney injury after coronary artery bypass grafting: methodological issues

Liu, Shaohua; Xue, Fu‐Shan; Zheng, Lirong; Hou, Hai-Jun

doi:10.1007/s11255-020-02428-8

Cited by 1 publication

(3 citation statements)

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“…The longer duration and higher level of sMb, the increased risk of severe AKI. The pressure-related muscle injury causing rhabdomyolysis recognized in the patients undergoing prolonged surgeries, including the spinal, urological, bariatric and some cardiac surgeries (10)(11)(12)(13)(14). In these situations, skeletal muscle (mainly gluteal and back muscles) is more prone to hypoxic injury and vascular compromise because of its peripheral location and longterm compression (24).…”

Section: Discussionmentioning

confidence: 99%

“…sMb has been proved to be more sensitive and specific than CK for predicting AKI ( 15 , 26 ). In addition, compared with off-pump procedures, on-pump procedures were associated with significantly higher sMb peak concentrations following coronary artery bypass grafting (CABG) ( 13 ). This suggested that CPB might exacerbate rhabdomyolysis and increase sMb.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study showed that myoglobin is an excellent skeletal muscle damage marker which could serve as an early diagnostic index for pressure induced deep tissue injury (9). Simultaneously, with the nephrotoxicity of myoglobin elucidated, the predictive value of serum myoglobin (sMb) for rhabdomyolysis-related AKI was reported in many surgical procedures (10)(11)(12)(13)(14). However, its correlation with AKI in the TAAD patients following TAR with FET had not been established.…”

Section: Introductionmentioning

confidence: 99%

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Serum Myoglobin Is Associated With Postoperative Acute Kidney Injury in Stanford Type A Aortic Dissection

et al. 2022

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BackgroundThe correlation between rhabdomyolysis and postoperative acute kidney injury has been reported in several surgical procedures. As a good predictor of rhabdomyolysis-related acute kidney injury, an elevated serum myoglobin level was often observed after total aortic arch replacement combined with frozen elephant trunk implantation. However, the correlation between serum myoglobin and acute kidney injury in such patients had not been established.MethodsTotally 398 stanford type A aortic dissection patients who underwent total aortic arch replacement combined with frozen elephant trunk implantation were enrolled in this retrospective study. The correlations between serum myoglobin and acute kidney injury as well as the 30-day mortality were assessed.ResultsOverall, 268(67.3%) patients had acute kidney injury (KDIGO stage 1 or higher) and 75(18.8%) had severe acute kidney injury (KDIGO stage 2&3). Patients who developed acute kidney injury had higher level of perioperative serum myoglobin than patients without acute kidney injury. After adjusting for known acute kidney injury risk factors, logarithmically transformed preoperative serum myoglobin [OR = 1.58 (95% CI, 1.26–1.95), P < 0.001] and postoperative day 1 serum myoglobin [OR = 3.47 (95%CI, 2.27–5.29), P < 0.001] were associated with severe acute kidney injury. These correlation persisted after adjustment for decline in filtration via change in serum creatinine (ΔCr) and biomarkers of cardiac and kidney injury, including N-terminal prohormone of brain natriuretic peptide, cardiac troponin I, creatine kinase-MB, serum creatinine and Cystatin C. Compared with the clinical model, sMb considerably improved the risk discrimination and reclassification for AKI.ConclusionFor stanford type A aortic dissection patients underwent total aortic arch replacement with frozen elephant trunk implantation, serum myoglobin can improve postoperative acute kidney injury risk classification. Rhabdomyolysis may be an important supplement to the existing knowledge on the mechanism of acute kidney injury.

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