Preoperative right heart hemodynamics predict postoperative acute kidney injury after heart transplantation.

Autor: Guven G; Thoraxcenter, Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus University Medical Center, Room Ba 577, 's-Gravendijkswal 230, 3015 CE, Rotterdam, The Netherlands.; Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands.; Department of Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey., Brankovic M; Thoraxcenter, Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus University Medical Center, Room Ba 577, 's-Gravendijkswal 230, 3015 CE, Rotterdam, The Netherlands.; School of Medicine, University of Belgrade, Belgrade, Serbia., Constantinescu AA; Thoraxcenter, Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus University Medical Center, Room Ba 577, 's-Gravendijkswal 230, 3015 CE, Rotterdam, The Netherlands., Brugts JJ; Thoraxcenter, Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus University Medical Center, Room Ba 577, 's-Gravendijkswal 230, 3015 CE, Rotterdam, The Netherlands., Hesselink DA; Division of Nephrology and Renal Transplantation, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands., Akin S; Thoraxcenter, Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus University Medical Center, Room Ba 577, 's-Gravendijkswal 230, 3015 CE, Rotterdam, The Netherlands.; Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands., Struijs A; Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands., Birim O; Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands., Ince C; Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands., Manintveld OC; Thoraxcenter, Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus University Medical Center, Room Ba 577, 's-Gravendijkswal 230, 3015 CE, Rotterdam, The Netherlands., Caliskan K; Thoraxcenter, Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus University Medical Center, Room Ba 577, 's-Gravendijkswal 230, 3015 CE, Rotterdam, The Netherlands. k.caliskan@erasmusmc.nl.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2018 May; Vol. 44 (5), pp. 588-597. Date of Electronic Publication: 2018 Apr 18.
DOI: 10.1007/s00134-018-5159-z
Abstrakt: Purpose: Acute kidney injury (AKI) frequently occurs after heart transplantation (HTx), but its relation to preoperative right heart hemodynamic (RHH) parameters remains unknown. Therefore, we aimed to determine their predictive properties for postoperative AKI severity within 30 days after HTx.
Methods: From 1984 to 2016, all consecutive HTx recipients (n = 595) in our tertiary referral center were included and analyzed for the occurrence of postoperative AKI staged by the kidney disease improving global outcome criteria. The effects of preoperative RHH parameters on postoperative AKI were calculated using logistic regression, and predictive accuracy was assessed using integrated discrimination improvement (IDI), net reclassification improvement (NRI), and area under the receiver operating characteristic curves (AUC).
Results: Postoperative AKI occurred in 430 (72%) patients including 278 (47%) stage 1, 66 (11%) stage 2, and 86 (14%) stage 3 cases. Renal replacement therapy (RRT) was administered in 41 (7%) patients. Patients with higher AKI stages had also higher baseline right atrial pressure (RAP; median 7, 7, 8, and in RRT 11 mmHg, p trend = 0.021), RAP-to-pulmonary capillary wedge pressure ratio (median 0.37, 0.36, 0.40, 0.47, p trend = 0.009), and lower pulmonary artery pulsatility index (PAPi) values (median 2.83, 3.17, 2.54, 2.31, p trend = 0.012). Higher RAP and lower PAPi values independently predicted AKI severity [adjusted odds ratio (OR) per doubling of RAP 1.16 (1.02-1.32), p = 0.029; of PAPi 0.85 (0.75-0.96), p = 0.008]. Based on IDI, NRI, and delta AUC, inclusion of these parameters improved the models' predictive accuracy.
Conclusions: Preoperative PAPi and RAP strongly predict the development of AKI early after HTx and can be used as early AKI predictors.
Databáze: MEDLINE
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