Relationship between intra-operative urine output and postoperative acute kidney injury in paediatric cardiac surgery: A retrospective observational study.

IF 4.2 2区医学 Q1 ANESTHESIOLOGY

European Journal of Anaesthesiology Pub Date : 2024-12-01 Epub Date: 2024-08-16 DOI:10.1097/EJA.0000000000002044

Dongyun Bie, Yinan Li, Hongbai Wang, Qiao Liu, Dou Dou, Yuan Jia, Su Yuan, Qi Li, Jianhui Wang, Fuxia Yan

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引用次数: 0

Abstract

Background: Intra-operative urine output (UO) has been shown to predict postoperative acute kidney injury (AKI) in adults; however, its significance in children undergoing cardiac surgery remains unknown.

Objective: To explore the association between intra-operative UO and postoperative AKI in children with congenital heart disease.

Design: A retrospective observational study.

Setting: A tertiary hospital.

Patients: Children aged >28 days and <6 years who underwent cardiac surgery at Fuwai Hospital from 1 April 2022 to 30 August 2022.

Main outcome measures: AKI was identified by the highest serum creatinine value within postoperative 7 days using Kidney Disease Improving Global Outcomes (KDIGO) criteria.

Results: In total, 1184 children were included. The incidence of AKI was 23.1% (273/1184), of which 17.7% (209/1184) were stage 1, 4.2% (50/1184) were stage 2, and others were stage 3 (1.2%, 14/1184). Intra-operative UO was calculated by dividing the total intra-operative urine volume by the duration of surgery and the actual body weight measured before surgery. There was no significant difference in median [IQR] intra-operative UO between the AKI and non-AKI groups (2.6 [1.4 to 5.4] and 2.7 [1.4 to 4.9], respectively, P = 0.791), and multivariate logistic regression analyses showed that intra-operative UO was not associated with postoperative AKI [adjusted odds ratio (OR) 0.971; 95% confidence interval (CI), 0.930 to 1.014; P = 0.182]. Regarding the clinical importance of severe forms of AKI, we further explored the association between intra-operative UO and postoperative moderate-to-severe AKI (adjusted OR 0.914; 95% CI, 0.838 to 0.998; P = 0.046).

Conclusions: Intra-operative UO was not associated with postoperative AKI during paediatric cardiac surgery. However, we found a significant association between UO and postoperative moderate-to-severe AKI. This suggests that reductions in intra-operative urine output below a specific threshold may be associated with postoperative renal dysfunction.

Trial registration: Clinicaltrials.gov identifier: NCT05489263.

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小儿心脏手术术中尿量与术后急性肾损伤之间的关系：一项回顾性队列研究。

背景：已证明术中尿量（UO）可预测成人术后急性肾损伤（AKI），但其对接受心脏手术的儿童的意义尚不清楚：目的：探讨先天性心脏病患儿术中尿量与术后急性肾损伤之间的关系：设计：回顾性观察研究：患者主要结果指标：采用肾脏疾病改善全球结局（KDIGO）标准，根据术后7天内血清肌酐最高值确定AKI：结果：共纳入 1184 名儿童。AKI发生率为23.1%（273/1184），其中17.7%（209/1184）为1期，4.2%（50/1184）为2期，其他为3期（1.2%，14/1184）。术中尿量的计算方法是将术中总尿量除以手术时间和术前测量的实际体重。AKI 组和非 AKI 组的术中尿量中位数[范围]无明显差异（分别为 2.6 [1.4 至 5.4] 和 2.7 [1.4 至 4.9]，P = 0.791），多变量逻辑回归分析显示术中尿量与术后 AKI 无关[调整后的几率比（OR）为 0.971；95% 置信区间（CI）为 0.930 至 1.014；P = 0.182]。关于重度 AKI 的临床重要性，我们进一步探讨了术中 UO 与术后中重度 AKI 之间的关系（调整后 OR 0.914；95% CI，0.838 至 0.998；P = 0.046）：结论：在儿科心脏手术中，术中尿崩症与术后 AKI 无关。结论：术中血氧饱和度与小儿心脏手术的术后 AKI 无关，但我们发现血氧饱和度与术后中度至重度 AKI 有明显关系。这表明，术中尿量减少到特定阈值以下可能与术后肾功能障碍有关：试验注册：Clinicaltrials.gov identifier：试验注册：Clinicaltrials.gov identifier：NCT05489263。

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

European Journal of Anaesthesiology 医学-麻醉学

CiteScore

6.90

自引率

11.10%

发文量

351

审稿时长

6-12 weeks

期刊介绍： The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).