Abstract：Objective To analyze the perioperative clinical data of children with congenital heart disease complicated by acute kidney injury (AKI) after cardiopulmonary bypass (CPB) surgery, and to explore potential factors influencing the prognosis. Methods A retrospective analysis was performed among 118 children with congenital heart disease who developed AKI within 48 hours after CPB surgery. Results In the 118 patients, 18 died after 48 hours of surgery. Compared with the survivors, the dead children had significantly higher incidence of cyanotic disease and Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) scores before surgery; during surgery, the dead children had significantly longer CPB time and aortic cross-clamping time, a significantly higher proportion of patients receiving crystalloid solution for myocardial protection, and a significantly higher mean blood glucose level. Within 48 hours after surgery, the dead children had significantly higher positive inotropic drug scores, significantly higher creatinine values, a significantly higher incidence of stage 3 AKI, a significantly higher proportion of patients receiving renal replacement the, and significantly higher usage of blood products (P < 0.05). The mortality rate of the patients increased with increased intraoperative blood glucose levels (P < 0.05). Patients with intraoperative blood glucose levels > 8.3 mmol/L had a significantly lower postoperative cumulative survival rate and a significantly shorter mean survival time than those with blood glucose levels ≤ 8.3 mmol/L (P < 0.05). Conclusions Intraoperative blood glucose levels are associated with the prognosis in children with congenital heart disease complicated by AKI after CPB surgery. Maintaining good intraoperative blood glucose control can improve the prognosis of the children.
DUAN Lian,HU Guo-Huang,JIANG Meng et al. Clinical characteristics and prognostic analysis of children with congenital heart disease complicated by postoperative acute kidney injury[J]. CJCP, 2017, 19(11): 1196-1201.
Sanchez-de-Toledo J, Perez-Ortiz A, Gil L, et al. Early initiation of renal replacement therapy in pediatric heart surgery is associated with lower mortality[J]. Pediatr Cardiol, 2016, 37(4):623-628.
[2]
Toda Y, Sugimoto K. AKI after pediatric cardiac surgery for congenital heart diseases-recent developments in diagnostic criteria and early diagnosis by biomarkers[J]. J Intensive Care, 2017(5):49.
[3]
Gist KM, Kaufman J, da Cruz EM, et al. A decline in intraoperative renal near-infrared spectroscopy is associated with adverse outcomes in children following cardiac surgery[J]. Pediatr Crit Care Med, 2016, 17(4):342-349.
[4]
Park SK, Hur M, Kim E, et al. Risk factors for acute kidney injury after congenital cardiac surgery in infants and children:a retrospective observational study[J]. PLoS One, 2016, 11(11):e0166328.
[5]
Jetton JG, Rhone ET, Harer MW, et al. Diagnosis and treatment of acute kidney injury in pediatrics[J]. Curr Treat Options Pediatr, 2016, 2(2):56-68.
[6]
Luo W, Zhu M, Huang R, et al. A comparison of cardiac post-conditioning and remote pre-conditioning in paediatric cardiac surgery[J]. Cardiol Young, 2011, 21(03):266-270.
[7]
Jenkins KJ, Kupiec JK, Owens PL. Development and validation of an agency for healthcare research and quality indicator for mortality after congenital heart surgery harmonized with risk adjustment for congenital heart surgery (RACHS-1) methodology[J]. J Am Heart Assoc, 2016, 5(5):e003028.
[8]
Pasquali SK, Hall M, Li JS, et al. Corticosteroids and outcome in children undergoing congenital heart surgery:analysis of the pediatric health information systems database[J]. Circulation, 2010, 122(21):2123-2130.
Sathya B, Davis R, Taveira T, et al. Intensity of peri-operative glycemic control and postoperative outcomes in patients with diabetes:a meta-analysis[J]. Diabetes Res Clin Pract, 2013, 102(1):8-15.
[11]
Neff LP, Cannon JW, Morrison JJ, et al. Clearly defining pediatric massive transfusion:Cutting through the fog and friction with combat data[J]. J Trauma Acute Care Surg, 2015, 78(1):22-29.
[12]
Tóth R, Breuer T, Cserép Z, et al. Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery[J]. Ann Thorac Surg, 2012, 93(6):1984-1990.
[13]
Kumar TK, Allen Ccp J, Spentzas Md T, et al. Acute kidney injury following cardiac surgery in neonates and young infants:experience of a single center using novel perioperative strategies[J]. World J Pediatr Congenit Heart Surg, 2016, 7(4):460-466.
[14]
Aydin SI, Seiden HS, Blaufox AD, et al. Acute kidney injury after surgery for congenital heart disease[J]. Ann Thorac Surg, 2012, 94(5):1589-1595.
[15]
Watkins SC, Williamson K, Davidson M, et al. Long-term mortality associated with acute kidney injury in children following congenital cardiac surgery[J]. Paediatr Anaesth, 2014, 24(9):919-926.
[16]
Sanchez-de-Toledo J, Perez-Ortiz A, Gil L, et al. Early initiation of renal replacement therapy in pediatric heart surgery is associated with lower mortality[J]. Pediatr Cardiol, 2016, 37(4):623-628.
[17]
Bojan M, Gioanni S, Vouhé PR, et al. Early initiation of peritoneal dialysis in neonates and infants with acute kidney injury following cardiac surgery is associated with a significant decrease in mortality[J]. Kidney Int, 2012, 82(4):474-481.
[18]
Greco G, Ferket BS, D'Alessandro DA, et al. Diabetes and the association of postoperative hyperglycemia with clinical and economic outcomes in cardiac surgery[J]. Diabetes Care, 2016, 39(3):408-417.
[19]
Giakoumidakis K, Nenekidis I, Brokalaki H. The correlation between peri-operative hyperglycemia and mortality in cardiac surgery patients:a systematic review[J]. Eur J Cardiovasc Nurs, 2012, 11(1):105-113.
[20]
Yates A, Dyke PC 2nd, Taeed R, et al. Hyperglycemia is a marker for poor outcome in the postoperative pediatric cardiac patient[J]. Pediatr Crit Care Med, 2006, 7(4):351-355.
[21]
Agus MS, Steil GM, Wypij D, et al. Tight glycemic control versus standard care after pediatric cardiac surgery[J]. N Engl J Med, 2012, 367(13):1208-1219.
[22]
Song Lou, Fan Ding, Cun Long, et al. Effects of peri-operative glucose levels on adverse outcomes in infants receiving open-heart surgery for congenital heart disease with cardiopulmonary bypass[J]. Perfusion, 2011, 26(2):133-139.
[23]
Qiao Y, Zhao Y, Liu Y, et al. miR-483-3p regulates hyperglycaemia-induced cardiomyocyte apoptosis in transgenic mice[J]. Biochem Biophys Res Commun, 2016, 477(4):541-547.
[24]
Tsai KH, Wang WJ, Lin CW, et al. NADPH oxidase-derived superoxide anion-induced apoptosis is mediated via the JNK-dependent activation of NF-κB in cardiomyocytes exposed to high glucose[J]. J Cell Physiol, 2012, 227(4):1347-1357.
