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. 2023 Sep;55(3):112-120.
doi: 10.1051/ject/2023029. Epub 2023 Sep 8.

Indexed oxygen delivery during pediatric cardiopulmonary bypass is a modifiable risk factor for postoperative acute kidney injury

Molly Dreher  1 , Jungwon Min  2 , Constantine Mavroudis  3 , Douglas Ryba  4 , Svetlana Ostapenko  2 , Richard Melchior  1 , Tami Rosenthal  1 , Muhammad Nuri  3 , Joshua Blinder  5
Affiliations

Indexed oxygen delivery during pediatric cardiopulmonary bypass is a modifiable risk factor for postoperative acute kidney injury

Molly Dreher et al. J Extra Corpor Technol. 2023 Sep.

Abstract

Background: Acute kidney injury after pediatric cardiac surgery is a common complication with few established modifiable risk factors. We sought to characterize whether indexed oxygen delivery during cardiopulmonary bypass was associated with postoperative acute kidney injury in a large pediatric cohort.

Methods: This was a retrospective analysis of patients under 1 year old undergoing cardiac surgery with cardiopulmonary bypass between January 1, 2013, and January 1, 2020. Receiver operating characteristic curves across values ranging from 260 to 400 mL/min/m2 were used to identify the indexed oxygen delivery most significantly associated with acute kidney injury risk.

Results: We included 980 patients with acute kidney injury occurring in 212 (21.2%). After adjusting for covariates associated with acute kidney injury, an indexed oxygen delivery threshold of 340 mL/min/m2 predicted acute kidney injury in STAT 4 and 5 neonates (area under the curve = 0.66, 95% CI = 0.60 - 0.72, sensitivity = 56.1%, specificity = 69.4%). An indexed oxygen delivery threshold of 400 mL/min/m2 predicted acute kidney injury in STAT 1-3 infants (area under the curve = 0.65, 95% CI = 0.58 - 0.72, sensitivity = 52.6%, specificity = 74.6%).

Conclusion: Indexed oxygen delivery during cardiopulmonary bypass is a modifiable variable independently associated with postoperative acute kidney injury in specific pediatric populations. Strategies aimed at maintaining oxygen delivery greater than 340 mL/min/m2 in complex neonates and greater than 400 mL/min/m2 in infants may reduce the occurrence of postoperative acute kidney injury in the pediatric population.

Keywords: Acute kidney injury; Cardiac surgery; Cardiopulmonary bypass; Indexed oxygen delivery; Pediatric.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Adjusted receiver operating characteristic analysis of area under the curve (AUC) for DO2i340 and any stage CS-AKI for neonates in STAT categories 4 and 5, n = 463 patients. A logistic regression model after adjusting for CPB time (> 90 min, ≤ 90 min), DHCA use (yes/no), nadir NP temperature, intraoperative transfusion (yes/no), patient race (White, Black, other), ethnicity (Hispanic, non-Hispanic), and preterm gestational age (yes/no), DO2i340 had the highest AUC of CS-AKI, 0.66 (95% CI = 0.60 – 0.72, sensitivity = 56.1%, specificity = 69.4%).
Figure 3
Figure 3
Adjusted receiver operating characteristic analysis of area under the curve (AUC) for DO2i400 and any stage CS-AKI for infants in STAT categories 1–3, n = 517 patients. A logistic regression model after adjusting for CPB time (>90 min, ≤90 min), DHCA use (yes/no), nadir NP temperature, intraoperative transfusion (yes/no), patient race (White, Black, other), and ethnicity (Hispanic, non-Hispanic), DO2i400 had the highest AUC of CS-AKI, 0.65 (95% CI = 0.58 – 0.72, sensitivity = 52.6%, specificity = 74.6%).
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References

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