Postoperative Acute Kidney Injury in Young Adults With Congenital Heart Disease

Fuhrman, Dana Y.; Nguyen, Lan; Sanchez‐de‐Toledo, Joan; Priyanka, Priyanka; Kellum, John A.

doi:10.1016/j.athoracsur.2019.01.017

Cited by 11 publications

(10 citation statements)

References 26 publications

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“…The incidence of AKI following pediatric cardiac surgery varies widely across different studies, ranging from 11% ( 20 ) to 52% ( 21 ). In this present study, the incidence of AKI was calculated as 14.5%, which was quite in accordance with the reported 14.1% by Lee et al ( 22 ) and 13.2% by Fuhrman et al ( 23 ). In our minds, different patient characteristics (e.g., age ranges, races, operation types, etc.…”

Section: Discussionsupporting

confidence: 93%

The Albumin-to-Fibrinogen Ratio Independently Predicts Acute Kidney Injury in Infants With Ventricular Septal Defect Undergoing Cardiac Surgery With Cardiopulmonary Bypass

et al. 2021

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Background: Acute kidney injury (AKI) is a common and serious complication faced by children following ventricular septal defect (VSD) surgery with cardiopulmonary bypass (CPB). The objective of this study was to explore potential predictors inherent to AKI.Methods: VSD infants who were scheduled for elective cardiac surgery with CPB from 2017 to 2020 were enrolled in this study. Based on the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) criteria, patients were divided into AKI and non-AKI groups. Univariate and multivariate logistic regression analyses were carried out in order to evaluate potential risk factors for AKI. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive probabilities of risk factors for AKI.Results: Of all the 338 enrolled VSD infants, 49 manifested AKI with an incidence of 14.5% (49/338). The ROC curve indicated that albumin-to-fibrinogen ratio (AFR) during CPB was a significant predictor of AKI [area under the curve (AUC), 0.711; p < 0.001]. Based on the univariate and multivariate logistic analyses, AFR during CPB [odds ratio (OR), 1.89; 95% confidence interval (CI), 1.22–2.76, p = 0.011] was the only independent risk factor for AKI.Conclusions: This study demonstrated that a low AFR (<9.35) during CPB was an independent risk factor for AKI in VSD infants following cardiac surgery with CPB.

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Section: Discussionsupporting

confidence: 93%

The Albumin-to-Fibrinogen Ratio Independently Predicts Acute Kidney Injury in Infants With Ventricular Septal Defect Undergoing Cardiac Surgery With Cardiopulmonary Bypass

et al. 2021

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“…Multiple systematic reviews have shown that MV can greatly increase the incidence of AKI in critically ill patients [ 28 , 29 ]. In addition, Fuhrman et al reported that AKI was associated with a longer duration of MV after cardiac procedures (OR, 1.47; 95% CI: 1.15–1.89) [ 30 ]. Therefore, we suggest that it may be beneficial to withdraw MV as soon as possible for patients undergoing AKI-CRRT, but further research and verification are needed to support this claim.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for mortality in patients undergoing continuous renal replacement therapy after cardiac surgery

Liu

Zhang

Yue

et al. 2021

BMC Cardiovasc Disord

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Background To investigate the risk factors for mortality in patients with acute kidney injury requiring continuous renal replacement therapy (AKI-CRRT) after cardiac surgery. Methods In this retrospective study, patients who underwent AKI-CRRT after cardiac surgery in our centre from January 2015 to January 2020 were included. Univariable and multivariable analyses were performed to identify the risk factors for in-hospital mortality. Results A total of 412 patients were included in our study. Of these, 174 died after AKI-CRRT, and the remaining 238 were included in the survival control group. Multivariable logistic regression analysis revealed that EuroSCORE > 7 (odds ratio [OR], 3.72; 95% confidence interval [CI], 1.92–7.24; p < 0.01), intraoperative bleeding > 1 L (OR, 2.14; 95% CI, 1.19–3.86; p = 0.01) and mechanical ventilation time > 70 h (OR, 5.03; 95% CI, 2.40–10.54; p < 0.01) were independent risk factors for in-hospital mortality in patients who had undergone AKI-CRRT. Our study also found that the use of furosemide after surgery was a protective factor for such patients (odds ratio, 0.48; 95% confidence interval, 0.25–0.92; p = 0.03). Conclusions In summary, the mortality of patients with AKI-CRRT after cardiac surgery remains high. The EuroSCORE, intraoperative bleeding and mechanical ventilation time were independent risk factors for in-hospital mortality. Continuous application of furosemide may be associated with a better outcome.

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“…The analysis of our present cohort of CHD patients with severe postoperative hyperbilirubinemia showed an overall incidence of postoperative AKI of 59.3% and an in-hospital mortality rate of 10.5%. The reported AKI incidences in CHD patients who underwent CPB cardiac surgery in previous studies ranged from 11 to 51% [ 9 , 10 , 11 , 12 , 13 ], and the in-hospital mortalities ranged from 1.1 to 4% [ 10 , 14 ]. The discrepancies were most likely attributed to the differences in disease severity of the included patients between the studies.…”

Section: Discussionmentioning

confidence: 99%

Severe postoperative hyperbilirubinemia in congenital heart disease

et al. 2021

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Purpose The purpose of our present study was to explore the characteristics and outcomes of congenital heart disease (CHD) patients with severe postoperative hyperbilirubinemia. Methods All patients who underwent cardiopulmonary bypass surgical treatment for CHD and had severe postoperative hyperbilirubinemia (total bilirubin [TB] ≥85.5 μmol/L) in our center between January 2015 and December 2018 were retrospectively screened. Univariate and multivariate analyses were employed to identify risk factors for the study endpoints, including postoperative acute kidney injury (AKI), in-hospital mortality, and long-term mortality. Results After screening, 86 patients were included in our present study. In-hospital mortality was 10.9%. Fifty-one (59.3%) patients experienced AKI, and four (4.7%) patients received continuous renal replacement therapy. Multivariate analysis identified that the peak TB concentration (P = 0.002) and duration of mechanical ventilation (P = 0.008) were independent risk factors for in-hospital mortality, and stage 3 AKI was an independent risk factor for long-term mortality. The optimal cutoff value for peak TB concentration was 125.9 μmol/L. Patients with a postoperative TB level ≥125.9 μmol/L had worse long-term survival. Conclusion Hyperbilirubinemia was a common complication after CHD surgery. CHD patients with severe postoperative hyperbilirubinemia ≥125.9 μmol/L and AKI had a higher risk of mortality.

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Postoperative Acute Kidney Injury in Young Adults With Congenital Heart Disease

Cited by 11 publications

References 26 publications

The Albumin-to-Fibrinogen Ratio Independently Predicts Acute Kidney Injury in Infants With Ventricular Septal Defect Undergoing Cardiac Surgery With Cardiopulmonary Bypass

The Albumin-to-Fibrinogen Ratio Independently Predicts Acute Kidney Injury in Infants With Ventricular Septal Defect Undergoing Cardiac Surgery With Cardiopulmonary Bypass

Risk factors for mortality in patients undergoing continuous renal replacement therapy after cardiac surgery

Severe postoperative hyperbilirubinemia in congenital heart disease

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