• J Am Heart Assoc · Aug 2020

    A Better Predictor of Acute Kidney Injury After Cardiac Surgery: The Largest Area Under the Curve Below the Oxygen Delivery Threshold During Cardiopulmonary Bypass.

    • Tomoya Oshita, Arudo Hiraoka, Kosuke Nakajima, Ryosuke Muraki, Masahisa Arimichi, Genta Chikazawa, Hidenori Yoshitaka, and Taichi Sakaguchi.
    • Department of Clinical Engineering The Sakakibara Heart Institute of Okayama Japan.
    • J Am Heart Assoc. 2020 Aug 4; 9 (15): e015566.

    AbstractBackground The aim of this study was to compare the predictive accuracy of acute kidney injury (AKI) after cardiac surgery using cardiopulmonary bypass for the largest area under the curve (AUC) below the oxygen delivery (DO2) threshold and the cumulative AUC below the DO2 threshold. Methods and Results From March 2017 to October 2019, 202 patients who had undergone cardiac surgery with cardiopulmonary bypass were enrolled. The perfusion parameters were recorded every 20 seconds, and the DO2 (10×pump flow index [L/min per m2]×[hemoglobin (g/dL)×1.36×arterial oxygen saturation (%)+partial pressure of arterial oxygen (mm Hg)×0.003]) threshold of 300 mL/min per m2 was considered to define sufficient DO2. The nadir DO2, the cumulative AUC below the [Formula: see text], and the largest AUC below the [Formula: see text] were used to predict the incidence of AKI. Postoperative AKI was observed in 12.4% of patients (25/202). By multivariable analysis, the largest AUC below the [Formula: see text] ≥880 (odds ratio [OR], 4.9; 95% CI, 1.2-21.5 [P=0.022]), preoperative hemoglobin concentration ≤11.6 g/dL (OR, 7.6; 95% CI, 2.0-32.3 [P=0.004]), and red blood cell transfusions during cardiopulmonary bypass ≥2 U (OR, 3.3; 95% CI, 1.0-11.1 [P=0.041]) were detected as independent risk factors for AKI. Receiver operating curve analysis revealed that the largest AUC below the [Formula: see text] was more accurate to predict postoperative AKI compared with the nadir DO2 and the cumulative AUC below the [Formula: see text] (differences between areas, 0.0691 [P=0.006] and 0.0395 [P=0.001]). Conclusions These data suggest that a high AUC below the [Formula: see text] is an important independent risk factor for AKI after cardiopulmonary bypass, which could be considered for risk prediction models of AKI.

      Pubmed     Free full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…