Linchuang shenzangbing zazhi (Jan 2021)

Correlation between preoperative cardiac function and postoperative acute kidney injury after cardiac surgery

  • Hou Ke-long,
  • Shen Xiao,
  • Li Jing,
  • Sun Fang,
  • Zou Lei,
  • Zhang Cui,
  • Mu Xin-wei

Abstract

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Objective To explore the correlation and prognosis between preoperative cardiac function and postoperative acute kidney injury（AKI）after cardiac surgery.Methods A total of 1,468 adult patients undergoing cardiac surgery were admitted into Intensive Care Unit of First Municipal Hospital from September 2017 and May 2019.According to the classification scheme of New York Heart Association（NYHA）,they were divided into four groups of NYHA class Ⅰ,Ⅱ,Ⅲ and Ⅳ.And they were assigned into four levels according to the interquartile range(P25/P50/P75)of preoperative NT-proBNP concentration.General data and clinical outcomes of four groups were compared.And multivariate Logistic regression analysis was utilized for examining the risk factors of postoperative AKI after cardiac surgery.Results Among them, 264 patients（18.0%）developed AKI.These patients with higher preoperative cardiac function classification and NT-proBNP concentration had a higher postoperative incidence of AKI（12.7%,13.1%,20.7%,35.5%,P<0.001;9.2%,11.2%,16.2%,37.9%,P<0.001）,a higher risk of postoperative complications（shock, low cardiac output syndrome & multiple organ failure）and longer duration of mechanical ventilation, hospital stay and ICU stay.The above indicators were statistically different（P<0.05）.Multivariate Logistic regression analysis revealed that independent risk factors for postoperative AKI:preoperative cardiac function classification（OR=1.43,95%CI:1.36～2.16,P=0.007）,preoperative cardiac function stratification（OR=1.64,95%CI:1.54～2.32,P<0.001）,serum creatinine, serum uric acid, neutrophil gelatinase-associated lipocalin, intraoperative red blood cell units and postoperative lactate.The area under receiver operating characteristic curve of NT-proBNP for predicting postopeartive AKI was 0.73（95%CI:0.69-0.77,P<0.001）.Conclusion Patients with higher cardiac function classification and NT-proBNP concentration have a worse clinical prognosis.For lowering the incidence of postoperative AKI,clinicians should actively correct anemia, reduce blood loss and blood transfusion, improve heart function and optimize volume management during perioperative period.

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