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- Title
Perioperative albuminuria and clinical model to predict acute kidney injury in paediatric cardiac surgery.
- Authors
Nautiyal, Arushi; Sethi, Sidharth Kumar; Sharma, Rajesh; Raina, Rupesh; Tibrewal, Abhishek; Akole, Romel; Gupta, Aditi; Bhan, Anil; Bansal, Shyam Bihari
- Abstract
Background: AKI is an important complication post cardiac surgery in children. An early diagnosis can help in mitigating complications and allow for prognostication. Urinary albumin:creatinine ratio (ACR) as a biomarker can provide a cheaper and more accessible AKI risk assessment and prediction. There is a paucity of paediatric literature regarding its utility. Methods: This was a prospective observational study, enrolling all children aged 1 month to 18 years, who underwent cardiac surgery, with use of cardiopulmonary bypass. Cohort was divided into groups < 2 years and ≥ 2 years for analyses to account for differences in physiological albumin excretion with age. Results: Of 143 children enrolled in the study, 36 developed AKI. In both age groups, the post-operative ACR was higher than pre-operative ACR among patients with and without AKI. In the group aged ≥ 2 years, the highest first post-operative ACR tertile (> 75.8 mg/g) predicted post-operative AKI after adjusting for clinical variables (adjusted RR, 11.71; 1.85–16.59). In the group aged < 2 years, the highest first post-operative ACR tertile (> 141.3 mg/g) predicted post-operative AKI in unadjusted analysis but not after adjusting for clinical variables (RR, 2.78; 0.70–6.65). For AKI risk prediction, AUC (95% CI) was highest after combining clinical model and pre-operative ACR for groups aged < 2 years [0.805 (0.713-0.896)] and ≥ 2 years [0.872 (0.772–0.973)]. Conclusions: This study provides evidence for use of albuminuria as a feasible biomarker in AKI prediction in children post cardiac surgery, especially when added to a clinical model. A higher resolution version of the Graphical abstract is available as Supplementary information.
- Subjects
CARDIAC surgery; PERIOPERATIVE care; SCIENTIFIC observation; CONFIDENCE intervals; PEDIATRICS; PHARMACOKINETICS; RISK assessment; CARDIOPULMONARY bypass; ACUTE kidney failure; ALBUMINURIA; LONGITUDINAL method; DISEASE risk factors
- Publication
Pediatric Nephrology, 2022, Vol 37, Issue 4, p881
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-021-05219-0