Volume-associated hemodynamic variables for prediction of cardiac surgery-associated acute kidney injury
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ORIGINAL ARTICLE
Volume‑associated hemodynamic variables for prediction of cardiac surgery‑associated acute kidney injury Jiarui Xu1,2,3,4 · Wuhua Jiang1,2,3,4 · Yang Li1,2,3,4 · Bo Shen1,2,3,4 · Ziyan Shen1,2,3,4 · Yimei Wang1,2,3,4,5 · Jiachang Hu1,2,3,4 · Yi Fang1,2,3,4,5 · Zhe Luo6 · Chunsheng Wang7 · Jie Teng1,2,3,4,5,8 · Xiaoqiang Ding1,2,3,4,5,8 · Jiawei Yu1,2,3,4,5 Received: 25 April 2019 / Accepted: 8 May 2020 © Japanese Society of Nephrology 2020
Abstract Background Delayed diagnosis of acute kidney injury (AKI) is common because the changes in renal function markers often lag injury. We aimed to find optimal non-invasive hemodynamic variables for the prediction of postoperative AKI and AKI renal replacement therapy (RRT). Methods The data were collected from 1,180 patients who underwent cardiac surgery in our hospital between March 2015 and Feb 2016. Postoperative central venous pressure (CVP), mean arterial pressure (MAP), heart rate, PaO2, and PaCO2 on ICU admission and daily fluid input and output (calculated as 24 h PFO) were monitored and compared between AKI vs. non-AKI and RRT vs non-RRT cases. Results The AKI and AKI-RRT incidences were 36.7% (n = 433) and 1.2% (n = 14). Low cardiac output syndromes (LCOSs) occurred significantly more in AKI and RRT than in non-AKI or non-RRT groups (13.2% vs. 3.9%, P 20% of basic preoperative systolic pressure and lasted for ≥ 2 h; (2) the requirement to administer ≥ 3 vasoactive agents (dopamine, dobutamine, epinephrine or norepinephrine) or a requirement for an intra-aortic balloon pump (IABP); (3) symptoms of impaired perfusion of the body including oliguria or anuria, coldness of the extremities, the consciousness level lowered, or a combination of these symptoms that persisted for ≥ 2 h [6, 11].
Clinical and Experimental Nephrology
Statistical analysis Statistical analysis was conducted using SPSS Statistics for Windows (ver. 22, IBM Corp.). Normally distributed data are presented as the mean ± SD; comparisons between groups were made using two independent sample t tests or ANOVA. Medians (P25, P75) are used to present nonparametric data. A Wilcoxon’s test was used to assess two dependent variables, a nonparametric Mann–Whitney U test for independent variables, and a Chi-squared test for group comparisons. Factors with significant differences in basic characteristics were first detected in a univariate logistic regression analyses, from which the one with significant differences were further analyzed in a multivariate logistic regression analysis, which was carried out to investigate the potential effects of multiple factors on AKI and AKI-RRT. Receiver-operating characteristic (ROC) analysis was used to derive predictive hemodynamic variables within 24 h for AKI and AKI–RRT. A P value
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