Intraoperative Blood Glucose Levels and Postoperative Acute Kidney Injury in Pediatric Patients Having Congenital Heart Surgery under Cardiopulmonary Bypass

IF 0.3 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Congenital Heart Disease Pub Date : 2023-01-01 DOI:10.32604/chd.2023.028017

Dongyun Bie, Hongbai Wang, Chaobin Zhang, Chunrong Wang, Yuan Jia, Su Yuan, Sheng Shi, Jiangshan Huang, Jianhui Wang, Fuxia Yan

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引用次数: 0

Abstract

Purpose: This study sought to explore the effect of intraoperative mean blood glucose levels and variability on postoperative acute kidney injury (AKI) in children undergoing congenital cardiac surgery. Methods: We conducted a prospective nested case-control study in children (age < 18 years) undergoing congenital heart surgery with cardiopulmonary bypass (CPB) at the Fuwai Hospital between April 01, 2022 and July 30, 2022. Cases were individuals who developed AKI within the first postoperative 7 days (AKI group) and controls were those without AKI (Non-AKI group) according to KDIGO criteria. AKI and Non-AKI groups unmatched and 1:1 matched by age, sex, and baseline serum creatinine were separately analyzed. Multivariate logistic and conditional logistic regressions were used to assess the associations between blood glucose variables and AKI. Results: 688 consecutively approached patients were included in the final analysis. On multivariate analysis, intra-CPB (adjusted odds ratio [OR] 0.802; 95% confidence interval [CI], 0.706 to 0.912; p = 0.001) and post-CPB (adjusted OR 0.830; 95% CI, 0.744 to 0.925; p = 0.001) blood glucose levels were associated with postoperative AKI. There were no significant differences in pre-CPB blood glucose (adjusted OR 0.926; 95% CI, 0.759 to 1.129; p = 0.446) or intraoperative glycemic fluctuations (adjusted OR 0.905; 95% CI, 0.723 to 1.132; p = 0.382) between AKI and Non-AKI groups. Results based on matched cases and controls were consistent with those from the unmatched analyses. Conclusion: Higher intraoperative blood glucose levels during and after CPB were protective factors against postoperative AKI in pediatric patients after congenital heart surgery.

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体外循环下先天性心脏手术患儿术中血糖水平与术后急性肾损伤的关系

目的:本研究旨在探讨术中平均血糖水平和变异性对先天性心脏手术患儿术后急性肾损伤(AKI)的影响。方法:对2022年4月1日至2022年7月30日在阜外医院行先天性心脏手术合并体外循环(CPB)的儿童(年龄< 18岁)进行前瞻性巢式病例对照研究。病例为术后第一个7天内发生AKI的个体(AKI组)，对照为根据KDIGO标准无AKI的个体(非AKI组)。AKI组和非AKI组按年龄、性别和基线血清肌酐不匹配和1:1匹配分别进行分析。采用多变量logistic回归和条件logistic回归来评估血糖变量与AKI之间的关系。结果:688例连续就诊的患者被纳入最终分析。多变量分析中，intra-CPB(调整优势比[OR] 0.802;95%置信区间[CI]， 0.706 ~ 0.912;p = 0.001)和cpb后(调整OR 0.830;95% CI, 0.744 ~ 0.925;p = 0.001)血糖水平与术后AKI相关。cpb前血糖差异无统计学意义(调整OR 0.926;95% CI, 0.759 ~ 1.129;p = 0.446)或术中血糖波动(调整or 0.905;95% CI, 0.723 ~ 1.132;p = 0.382)。匹配病例和对照的结果与未匹配分析的结果一致。结论:CPB期间和之后较高的术中血糖水平是儿童先心病术后AKI的保护因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Congenital Heart Disease CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

0.40

自引率

33.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Congenital Heart Disease is an open-access journal focusing on congenital heart disease in children and adults. Though the number of infants born with heart disease each year is relatively small (approximately 1% of the population), advances in treating such malformations have led to increased life spans for this population. Consequently, today most patients treated for congenital heart disease are over the age of 20. What are the special needs of adults with congenital heart disease? What are the latest developments in the care of the fetus, infants, and children? Who should treat these patients? How should they be treated? Congenital Heart Disease focuses on these questions and more. Conceived as a forum for the most up-to-date information on congenital heart disease, the journal is led by Editor-in-Chief Vladimiro L. Vida, MD, Ph.D., Professor in Cardiac Surgery, University of Padua in Italy, as well as an international editorial board. Congenital Heart Disease publishes articles on heart disease as it relates to the following areas: • Basic research of congenital heart disease • Clinical pediatric and adult cardiology • Cardiac imaging • Preventive cardiology • Diagnostic and interventional cardiac catheterization • Electrophysiology • Surgery • Long-term follow-up, particularly as it relates to older children and adult congenital heart disease • Exercise and exercise physiology in the congenital patient • Post-op and critical care • Common disorders such as syncope, chest pain, murmurs, as well as acquired disorders such as Kawasaki syndrome The journal includes clinical studies, invited editorials, state-of-the-art reviews, case reports, articles focusing on the history and development of congenital heart disease, and CME material. Occasional issues focus on special topics. Readership: Congenital Heart Disease was created for pediatric cardiologists; adult cardiologists who care for patients with congenital heart disease; pediatric and pediatric cardiology nurses; surgeons; radiologists; anesthesiologists; critical care physicians and nurses; and adult support staff involved in the care of patients with congenital heart disease.