Risk factors for acute kidney injury after pediatric cardiac surgery: a meta-analysis

Abstract

Background Cardiac surgery-associated acute kidney injury (AKI) is associated with increased morbidity and mortality in both adults and children. Objectives This study aimed to identify clinical risk factors for AKI following cardiac surgery in the pediatric population. Data sources PubMed/MEDLINE, Embase, Scopus, and reference lists of relevant articles were searched for studies published by August 2020. Study eligibility criteria Studies were included if (1) the population consisted of pediatric patients (< 18 years old), (2) patients underwent cardiac surgery, (3) risk factors were compared between patients who developed AKI and those who did not, and (4) studies were prospective or retrospective observational studies or randomized controlled trials. Participants and interventions Children undergoing pediatric cardiac surgery.Study appraisal and synthesis methods Random-effects meta-analysis was performed, comparing potential risk factors between pediatric patients who developed CS-AKI and those who did not. Results Sixty-one publications including a total of 19,680 participants (AKI: 7257 participants; no AKI: 12,423 participants) were included from studies published between 2008 and 2020. The pooled estimated incidence of AKI was 34.3% (95% confidence interval 30.0-38.8%, I 2 = 96.8%). Binary risk factors that were significantly and consistently associated with AKI were the presence of pulmonary hypertension, cyanotic heart disease, univentricular heart, risk adjustment for congenital heart surgery 1 (RACHS-1) score ≥ 3, vasopressor use, cardiopulmonary bypass use, reoperation, and sepsis. Significant continuous risk factors included younger age, lower body weight, lower preoperative creatinine, higher preoperative estimated glomerular filtration rate (eGFR), higher RACHS-1 score, longer surgery time, longer cardiopulmonary bypass time, longer aortic cross-clamp time, and higher red blood cell transfusion volume. Limitations Results are limited by heterogeneity and potential residual confounding. Conclusions and implications of key findings Our meta-analysis identified clinical risk factors that are associated with AKI in children undergoing cardiac surgery. This might help clinicians anticipate and manage more carefully this population and implement standardized preventive strategies. Systematic review registration number CRD42021262699.

Machine Learning–Based Prediction of Acute Kidney Injury Following Pediatric Cardiac Surgery: Model Development and Validation Study

“…This method is a model-agnostic explanation technique that has been widely used to interpret the contribution of predictors to the model output [37,38]. Consistent with an updated systemic review, we found that lower baseline SCr, longer perfusion time, longer operation time, higher baseline eGFR, younger age, and lower body weight are associated with the development of pediatric CSA-AKI [3,39]. We also identified body length, intraoperative blood loss, serum potassium, and serum calcium as important predictors of CSA-AKI.…”

“…Machine learning approaches have also shown promising performance in the early prediction of adult CSA-AKI [14][15][16][17][18][19], but their predictive performance for CSA-AKI in the pediatric population has not been tested. The primary diseases, underlying pathophysiology, and risk factors of CSA-AKI in pediatric patients are significantly different from those in adult patients [20][21][22]. Therefore, the existing prediction models for adult CSA-AKI are not applicable to pediatric patients.…”

[Retracted] Meta‐Resolve of Risk Factors for Nosocomial Infection in Patients Undergoing Thoracic Surgery

“…And there is one of the following: (1) The urethral leukocytes are 5 or more high-power fields for men and 10 or more high-power fields for women. (2) Urinary tract infection is clinically diagnosed, or the response to antimicrobial therapy is confirmed as having a urinary tract infection [ 13 ].…”

Kidney disease and congenital heart disease: Partnership for life

“…(Van den Eynde et al, 2021)The most notable risk factors for developing AKI included younger age, lower body weight, prolonged cardiopulmonary bypass time, perioperative fluid overload, and the presence of low cardiac output after surgery (Khuong et al, 2021). In addition, in the meta-analysis by Van den Eynde et al, the authors found that other risk factors for developing AKI included presence of pulmonary hypertension, cyanotic heart disease, univentricular heart, RACHS-1 score ≥ 3, vasopressor use, cardiopulmonary bypass use, reoperation, and sepsis (Van den Eynde et al, 2022a). …”