Impact of Oxygen Delivery on the Development of Acute Kidney Injury in Patients Undergoing Valve Heart Surgery
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Patients
2.3. Study Variables and Definitions
2.4. Anesthesia and CPB Management
Intraoperative Care and Anesthesia
2.5. Statistical Analysis
3. Results
Multivariable Model for DO2i and CSA-AKI
4. Discussion
Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Total (n 782) | CSA-AKI (231) | CSA-AKI Free (551) | p Value |
---|---|---|---|---|
Preoperative data | ||||
Population characteristics | ||||
Age, y, median (IQR) | 70 (63–77) | 74 (67–78) | 69 (62–76) | <0.001 |
Female | 381 (48.7) | 112 (48.5) | 269 (48.8) | 0.932 |
BMI, kg/m2, median (IQR) | 27.0 (24.4–29.8) | 27.1 (24.6–29.3) | 27.0 (24.3–30.0) | 0.923 |
EuroSCORE II, median (IQR) | 1.7 (1.2–2.1) | 1.8 (1.4–2.2) | 1.6 (1.2–2.0) | <0.001 |
Smoker | 163 (20.8) | 52 (22.5) | 111 (20.1) | 0.043 |
Current Smoker | 63 (8.1) | 10 (4.3) | 53 (9.6) | 0.043 |
Hypertension | 689 (88.1) | 216 (93.5) | 473 (85.8) | 0.003 |
Diabetes mellitus | 154 (19.7) | 54 (23.4) | 100 (18.1) | 0.141 |
Dyslipidemia | 574 (73.4) | 176 (76.2) | 398 (72.2) | 0.253 |
COPD | 43 (5.5) | 12 (5.2) | 31 (5.6) | 0.533 |
Peripheral Vascular Disease | 17 (2.2) | 8 (3.5) | 9 (1.6) | 0.109 |
Prior Cardiac Surgery | 49 (6.3) | 19 (8.2) | 30 (5.4) | 0.339 |
Prior Stroke | 36 (4.6) | 17 (7.4) | 19 (3.4) | 0.106 |
AF | 257 (33.0) | 75 (32.3) | 182 (33.0) | 0.948 |
NYHA 3 | 230 (29.4) | 73 (31.6) | 157 (28.5) | 0.371 |
NYHA 4 | 8 (1.0) | 4 (1.7) | 4 (0.7) | |
Preoperative SCr, median (IQR) | 0.8 (0.7–0.9) | 1.21 (0.7–1.7) | 0.95 (0.7–1.2) | <0.001 |
LVEF | 62 (58–65) | 62 (58–65) | 62 (59–65) | 0.740 |
Intraoperative data | ||||
CBP time, min, median (IQR) | 97 (80–123) | 102 (83–131) | 95 (80–117) | <0.001 |
Aortic Cross-Clamp time, min, median (IQR) | 72 (57–93) | 75 (60–99) | 70 (56–91) | <0.001 |
Surgical procedure | ||||
Aortic Surgery | 374 (47.7) | 105 (45.4) | 269 (48.8) | 0.007 |
Mitral Surgery | 170 (21.7) | 48 (20.8) | 122 (22.1) | 0.007 |
Mitral + Aortic Surgery | 115 (14.7) | 38 (16.5) | 77 (14.0) | 0.007 |
Mitral + Tricuspid Surgery | 87 (11.1) | 24 (10.4) | 63 (11.4) | 0.007 |
Mitral + Aortic + Tricuspid Surgery | 24 (3.1) | 11 (4.8) | 13 (2.4) | 0.007 |
Tricuspid Surgery | 12 (1.5) | 5 (2.2) | 7 (1.3) | 0.007 |
Red blood cell Transfusion | 94 (12.0) | 42 (18.2) | 52 (9.5) | <0.001 |
Lactate, mg/dL | 25 (19–32) | 26 (21–33) | 24 (19–32) | <0.001 |
DO2 indexed start CPB (mL min−1 m−2) | 315.6 (283.0–350.2) | 296.4 (330.6–271.3) | 322.2 (290.3–357.3) | <0.001 |
DO2 indexed end CPB (mL min−1 m−2) | 316.8 (284.8–354.9) | 298.4 (272.1–330.8) | 323.3 (293.0–351.7) | <0.001 |
Univariate Analysis | ||
---|---|---|
Variables | OR (95% CI) | p Value |
Age, y | 1.06 (1.03–1.07) | <0.001 |
CBP time, min | 1.01 (1.00–1.02) | <0.001 |
Aortic Cross-Clamp time, min | 1.01 (1.01–1.02) | 0.001 |
DO2 indexed during CBP (mL/min/m2) | 0.99 (0.98–0.99) | <0.001 |
DO2 indexed end CBP (mL/min/m2) | 0.99 (0.99–0.99) | 0.002 |
Multivariable Analysis | ||
---|---|---|
Variables | OR (95% CI) | p Value |
Age, y | 1.07 (1.03–1.11) | <0.001 |
CBP time, min | 1.01 (1.01–1.02) | <0.001 |
DO2 indexed during CPB < 303 mL min−1 m−2 | 1.90 (1.12–3.24) | 0.018 |
DO2 indexed end CPB < 295 mL min−1 m−2 | 1.94 (1.15–3.29) | 0.014 |
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Carrasco-Serrano, E.; Jorge-Monjas, P.; Muñoz-Moreno, M.F.; Gómez-Sánchez, E.; Priede-Vimbela, J.M.; Bardají-Carrillo, M.; Cubero-Gallego, H.; Tamayo, E.; Ortega-Loubon, C. Impact of Oxygen Delivery on the Development of Acute Kidney Injury in Patients Undergoing Valve Heart Surgery. J. Clin. Med. 2022, 11, 3046. https://doi.org/10.3390/jcm11113046
Carrasco-Serrano E, Jorge-Monjas P, Muñoz-Moreno MF, Gómez-Sánchez E, Priede-Vimbela JM, Bardají-Carrillo M, Cubero-Gallego H, Tamayo E, Ortega-Loubon C. Impact of Oxygen Delivery on the Development of Acute Kidney Injury in Patients Undergoing Valve Heart Surgery. Journal of Clinical Medicine. 2022; 11(11):3046. https://doi.org/10.3390/jcm11113046
Chicago/Turabian StyleCarrasco-Serrano, Elena, Pablo Jorge-Monjas, María Fé Muñoz-Moreno, Esther Gómez-Sánchez, Juan Manuel Priede-Vimbela, Miguel Bardají-Carrillo, Héctor Cubero-Gallego, Eduardo Tamayo, and Christian Ortega-Loubon. 2022. "Impact of Oxygen Delivery on the Development of Acute Kidney Injury in Patients Undergoing Valve Heart Surgery" Journal of Clinical Medicine 11, no. 11: 3046. https://doi.org/10.3390/jcm11113046