Predictive value of oxygen delivery and regional oxygen saturation during cardiopulmonary bypass for cardiac surgery-associated acute kidney injury in neonates with congenital heart disease.

OBJECTIVE

To explore the predictive value of intraoperative oxygen delivery (DO2) and renal regional oxygen saturation (rSO2) during cardiopulmonary bypass (CPB) for cardiac surgery-associated acute kidney injury (CS-AKI) in neonates with congenital heart disease (CHD).

METHODS

A total of 235 neonates who underwent CPB-assisted cardiac surgery were enrolled and divided into CS-AKI and non-CS-AKI groups according to the occurrence of postoperative CS-AKI. Perioperative clinical data, intraoperative DO2 and renal rSO2 as well as postoperative recovery indicators were collected. Binary logistic regression analysis was performed to screen independent risk factors for CS-AKI. Based on the independent predictors, a predictive nomogram was constructed and validated internally and externally. The predictive value of DO2 and rSO2 for CS-AKI was assessed.

RESULTS

Aortic cross-clamp (ACC) time, DO2 at 5 minutes post-ACC (T2), DO2 at 5 minutes after aortic opening (T3), the minimum renal rSO2 during CPB (R_min), and renal rSO2 at CPB termination (R_post) were independent influencing factors for CS-AKI. The combined application of the above four DO2 and rSO2 indicators yielded the optimal predictive efficacy for CS-AKI, with an (AUC) of 0.924. The constructed nomogram exhibited good discriminatory power, and external validation confirmed its excellent predictive efficiency.

CONCLUSION

ACC time, DO2 (T2, T3) and renal rSO2 (R_min, R_post) were independent determinants of CS-AKI in CHD neonates. The nomogram established based on these intraoperative oxygenation indices achieved superior predictive performance for postoperative CS-AKI.