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Войти в исследования Pediatric research · 2026
Renal regional oxygenation during pediatric cardiac surgery predicts acute kidney injury: a prospective cohort study with model comparisons.
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Gao Zhengzheng, Wang Xiaoxue, Hua Lei, Li Lijing, Wang Fang, Zhang Jianmin
Аннотация
BACKGROUND: Acute kidney injury (AKI) is a common complication after pediatric cardiac surgery using cardiopulmonary bypass (CPB). This study evaluated renal regional oxygen saturation (R-rSO₂), measured via near-infrared spectroscopy (NIRS), as an AKI predictor.
METHODS: 120 pediatric patients undergoing CPB-assisted congenital heart surgery were prospectively enrolled. Continuous intraoperative R-rSO₂ monitoring was performed. Four multivariable logistic regression models (adjusted for age, pre-SCr, pre-hemoglobin, RACHS-2, cyanosis, and CPB time) assessed distinct R-rSO₂ metrics during CPB for predicting AKI (pRIFLE criteria).
RESULTS: AKI incidence was 35.8% (n = 43). The model using the area under the curve (AUC) for R-rSO₂ decrease ≥5% during CPB showed superior predictive performance (C-index = 0.854) and fit. Within this model, a greater AUC for R-rSO₂ decrease ≥5% during CPB was independently associated with increased AKI risk (OR 1.02, 95% CI 1.00-1.03, P = 0.014). Prolonged CPB duration (OR 1.02, 95% CI 1.00-1.04, P = 0.028) and lower preoperative serum creatinine (OR 0.87, 95% CI 0.76-0.99, P = 0.031) were also significant predictors. AKI correlated with prolonged ventilation (P < 0.001) and higher costs (P < 0.001).
CONCLUSION: Renal tissue desaturation during CPB, quantified as the AUC for R-rSO₂ decrease ≥5%, is significantly associated with postoperative AKI in children. Higher preoperative creatinine (mature function) was protective, while longer CPB time increased risk.
IMPACT: The cumulative burden of renal desaturation specifically during CPB is the outstanding intraoperative predictor of postoperative AKI in children undergoing congenital heart surgery. This study defines a quantitative metric-the cumulative area under the curve for renal regional oxygen saturation decrease ≥5% during CPB-which demonstrates high specificity and provides a potential, actionable intraoperative monitoring threshold for predicting AKI risk.
METHODS: 120 pediatric patients undergoing CPB-assisted congenital heart surgery were prospectively enrolled. Continuous intraoperative R-rSO₂ monitoring was performed. Four multivariable logistic regression models (adjusted for age, pre-SCr, pre-hemoglobin, RACHS-2, cyanosis, and CPB time) assessed distinct R-rSO₂ metrics during CPB for predicting AKI (pRIFLE criteria).
RESULTS: AKI incidence was 35.8% (n = 43). The model using the area under the curve (AUC) for R-rSO₂ decrease ≥5% during CPB showed superior predictive performance (C-index = 0.854) and fit. Within this model, a greater AUC for R-rSO₂ decrease ≥5% during CPB was independently associated with increased AKI risk (OR 1.02, 95% CI 1.00-1.03, P = 0.014). Prolonged CPB duration (OR 1.02, 95% CI 1.00-1.04, P = 0.028) and lower preoperative serum creatinine (OR 0.87, 95% CI 0.76-0.99, P = 0.031) were also significant predictors. AKI correlated with prolonged ventilation (P < 0.001) and higher costs (P < 0.001).
CONCLUSION: Renal tissue desaturation during CPB, quantified as the AUC for R-rSO₂ decrease ≥5%, is significantly associated with postoperative AKI in children. Higher preoperative creatinine (mature function) was protective, while longer CPB time increased risk.
IMPACT: The cumulative burden of renal desaturation specifically during CPB is the outstanding intraoperative predictor of postoperative AKI in children undergoing congenital heart surgery. This study defines a quantitative metric-the cumulative area under the curve for renal regional oxygen saturation decrease ≥5% during CPB-which demonstrates high specificity and provides a potential, actionable intraoperative monitoring threshold for predicting AKI risk.