Use of cerebral oxygen saturation and hemoglobin concentration to predict acute kidney injury after cardiac surgery

Balcı, Canan; Haftaci, Engin; Kunt, Atike Tekeli

doi:10.1177/0300060517741064

Cited by 12 publications

(5 citation statements)

References 21 publications

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“…Monitoring of cerebral oxygenation was found to provide a novel method for precisely guiding mean arterial blood pressure (MAP) targets during cardiac surgery. Results from this study was in agreement with previous studies that showed cerebral oximetry monitoring provides better outcome on the kidney following cardiac surgery probably by improving the regional perfusion to the kidney during cardiopulmonary bypass [24][25][26].…”

Section: Plos Onesupporting

confidence: 92%

Intraoperative cerebral oximetry in open heart surgeries reduced postoperative complications: A retrospective study

et al. 2021

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Cardiothoracic surgeries are life-saving procedures but often it results in various complications. Intraoperative cerebral oximetry monitoring used to detect regional cerebral oxygen saturation (rScO2) is a non-invasive method that provides prognostic importance in cardiac surgery. The main aim of the present study was to evaluate the association of intraoperative cerebral oxygen monitoring during cardiac surgery on postoperative complications. This was a case-controlled retrospective study conducted on adult patients, who underwent open-heart surgery in National Heart Institute, Malaysia. The case group comprised patients on protocolized cerebral oximetry monitoring. They were treated using a standardized algorithm to maintain rScO2 not lower than 20% of baseline rScO2. The control group comprised patients with matched demographic background, preoperative risk factors, and type of surgical procedures. Propensity score stratification was utilized to contend with selection bias. Retrospective analysis was performed on 240 patients (case group) while comparing it to 407 patients (control group). The non-availability of cerebral oximetry monitoring during surgery was the prominent predictor for all outcome of complications; stroke (OR: 7.66), renal failure needing dialysis (OR: 5.12) and mortality (OR: 20.51). Postoperative complications revealed that there were significant differences for risk of mortality (p<0.001, OR = 20.51), renal failure that required dialysis (p<0.001, OR = 5.12) and stroke (p <0.05, OR = 7.66). Protocolized cerebral oximetry monitoring during cardiothoracic surgeries was found to be associated with lower incidence of stroke, renal failure requiring dialysis and mortality rate.

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Section: Plos Onesupporting

confidence: 92%

Intraoperative cerebral oximetry in open heart surgeries reduced postoperative complications: A retrospective study

et al. 2021

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“…One must note that this population was remarkably different regarding anatomy and type of surgery than the population we studied. However, in another study involving 45 adult patients undergoing cardiac surgery under CPB, an association was found between lower values of cerebral oxygenation and higher incidence of AKI (odds ratio, 0.667; 95% confidence interval, 0.485–0.917; p = 0.013) [ 24 ]. Of note, both studies including adult patients were conducted solely in on-pump cardiac surgery and not in off-pump procedures.…”

Section: Discussionmentioning

confidence: 99%

Comparison of renal region, cerebral and peripheral oxygenation for predicting postoperative renal impairment after CABG

Keijzer

Poterman

Absalom

et al. 2021

J Clin Monit Comput

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Patients undergoing coronary artery bypass grafting (CABG) are at risk of developing postoperative renal impairment, amongst others caused by renal ischemia and hypoxia. Intra-operative monitoring of renal region tissue oxygenation (SrtO2) might be a useful tool to detect renal hypoxia and predict postoperative renal impairment. Therefore, the aim of this study was to assess the ability of intra-operative SrtO2 to predict postoperative renal impairment, defined as an increase of serum creatinine concentrations of > 10% from individual baseline, and compare this with the predictive abilities of peripheral and cerebral tissue oxygenation (SptO2 and SctO2, respectively) and renal specific tissue deoxygenation. Forty-one patients undergoing elective CABG were included. Near-infrared spectroscopy (NIRS) was used to measure renal region, peripheral (thenar muscle) and cerebral tissue oxygenation during surgery. Renal region specific tissue deoxygenation was defined as a proportionally larger decrease in SrtO2 than SptO2. ROC analyses were used to compare predictive abilities. We did not observe an association between tissue oxygenation measured in the renal region and cerebral oxygenation and postoperative renal impairment in this small retrospective study. In contrast, SptO2 decrease > 10% from baseline was a reasonable predictor with an AUROC of 0.767 (95%CI 0.619 to 0.14; p = 0.010). Tissue oxygenation of the renal region, although non-invasively and continuously available, cannot be used in adults to predict postoperative renal impairment after CABG. Instead, peripheral tissue deoxygenation was able to predict postoperative renal impairment, suggesting that SptO2 provides a better indication of ‘general’ tissue oxygenation status.Registered at ClinicalTrials.gov: NCT01347827, first submitted April 27, 2011.

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“…Previous studies have found that decreasing hemoglobin levels are associated with the development of AKI in various patients, including neonates and those undergoing cardiac surgery or percutaneous coronary intervention. [14][15][16] Decreased hemoglobin levels in patients with ICH may be caused by intracranial bleeding, malnutrition, and pathophysiological consumption. Consequently, inadequate hemoglobin cannot provide sufficient oxygen to the renal tissue, leading to subsequent renal injury.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Acute Kidney Injury in Intracerebral Hemorrhage Patients Using Machine Learning

She,

Shen,

Luo

et al. 2023

NDT

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Background: Acute kidney injury (AKI) is prevalent in patients with intracerebral hemorrhage (ICH) and is associated with mortality. This study aimed to verify the predictive accuracy of different machine learning algorithms for AKI in patients with ICH using a large dataset. Methods: A total of 1366 ICH patients received treatments between 2001 and 2012 from the Medical Information Mart for Intensive Care-III (MIMIC-III) database were identified based on the ICD-9 code: 431. The main outcome of AKI during hospitalizations was confirmed based on the KDIGO criteria. Overall, ICH patients were randomly divided into the training cohort and validation cohort with the ratio of 7:3. Six machine learning algorithms including extreme gradient boosting, logistic, light gradient boosting machine, random forest, adaptive boosting, support vector machine were trained in the training cohort with the 5-fold cross-validation method to predict the AKI. The predictive accuracy of those algorithms was compared by area under the receiver operating characteristics curve (AUC). Results: A total of 1213 ICH patients were included with the incidence of AKI being 29.3%. The incidence of AKI was 29.3% among the 1213 patients with ICH. The AKI group had higher 30-day mortality (p<0.001), longer ICU stay (p<0.001), and longer hospital stay (p<0.001). Among the six machine learning algorithms, the random forest performed the best in predicting AKI in both the training cohort (AUC=1.000) and the validation cohort (AUC=0.698). The top five features in the random forest algorithm-based model were platelets, serum creatinine, vancomycin, hemoglobin, and hematocrit. Conclusion:The random forest algorithm-based predictive model we developed incorporating important features, including platelet count, serum creatinine level, vancomycin level, hemoglobin level, and hematocrit level, performed the best in predicting AKI among patients with ICH.

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Use of cerebral oxygen saturation and hemoglobin concentration to predict acute kidney injury after cardiac surgery

Cited by 12 publications

References 21 publications

Intraoperative cerebral oximetry in open heart surgeries reduced postoperative complications: A retrospective study

Intraoperative cerebral oximetry in open heart surgeries reduced postoperative complications: A retrospective study

Comparison of renal region, cerebral and peripheral oxygenation for predicting postoperative renal impairment after CABG

Prediction of Acute Kidney Injury in Intracerebral Hemorrhage Patients Using Machine Learning

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