Preoperative platelet count, preoperative hemoglobin concentration and deep hypothermic circulatory arrest duration are risk factors for acute kidney injury after pulmonary endarterectomy: a retrospective cohort study

Abstract

BackgroundAcute kidney injury (AKI) is a major postoperative morbidity of patients undergoing cardiac surgery and has a negative effect on prognosis. The kidney outcomes after pulmonary endarterectomy (PEA) have not yet been reported; However, several perioperative characteristics of PEA may induce postoperative AKI. The objective of our study was to identify the incidence and risk factors for postoperative AKI and its association with short-term outcomes.MethodsThis was a single-center, retrospective, observational, cohort study. Assessments of AKI diagnosis was executed based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria.ResultsA total of 123 consecutive patients who underwent PEA between 2014 and 2018 were included.The incidence of postoperative AKI was 45% in the study population. Stage 3 AKI was associated with worse short-term outcomes and 90-day mortality (p < 0.001, p = 0.002, respectively). The independent predictors of postoperative AKI were the preoperative platelet count (OR 0.992; 95%CI 0.984–0.999; P = 0.022), preoperative hemoglobin concentration (OR 0.969; 95%CI 0.946–0.993; P = 0.01) and deep hypothermic circulatory arrest (DHCA) time (OR 1.197; 95%CI 1.052–1.362; P = 0.006) in the multivariate analysis.ConclusionThe incidence of postoperative AKI was relatively high after PEA compared with other types of cardiothoracic surgeries. The preoperative platelet count, preoperative hemoglobin concentration and DHCA duration were modifiable predictors of AKI, and patients may benefit from some low-risk, low-cost perioperative measures.

Analysis of Risk Factors for Perioperative Acute Kidney Injury and Management Strategies

“…Zhang et al (51) published the first report on a complication study of 123 patients diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) who underwent pulmonary endarterectomy (PEA). Their data suggested that the incidence of postoperative AKI was 45% (Table 2); that preoperative platelet count, hemoglobin concentration, and duration of deep hypothermic circulation stagnation were independent factors associated with AKI; and that renal protection strategies should be prioritized in the perioperative management of such procedures (51). However, some unknown confounding factors (such as perioperative nephrotoxic drug use) were not explicitly excluded in this study, and there are not enough other relevant studies due to the low incidence of CTEPH, resulting in some limitations of the findings.…”

Identification of risk factors for acute kidney injury after pulmonary endarterectomy with cardiopulmonary bypass

“…We read with great interest the recent article by Zhang et al [1] determining the risk factors of acute kidney injury (AKI) after pulmonary endarterectomy with cardiopulmonary bypass (CPB). By univariate and multivariate logistic regression analyses, they showed that preoperative platelet count and hemoglobin level, and deep hypothermic circulatory arrest time were the independent predictors of postoperative AKI.…”

Anesthesia Management at Fuwai Hospital: Practice, Evidence and Outcomes<span style="font-size:12px;"><span style="font-size:9px;"></span></span>

“…The reported incidences of AKI in cardiovascular surgical patients at Fuwai Hospital vary from 7.5% to 77.6%, with the dialysis dependence incidence between 7.9% and 58.9%. [92][93][94] The spectrum of postoperative pulmonary complications (PPCs) in cardiovascular surgical patients ranges from transient hypoxemia, acute respiratory distress syndrome (ARDS), pulmonary infection, atelectasis, pulmonary edema, etc. For example, the reported incidence of postoperative pulmonary infection and atelectasis at Fuwai Hospital was 5.8% and 1.7%, respectively.…”