Furosemide Responsiveness Predicts Acute Kidney Injury Progression After Cardiac Surgery.

Autor:	Su Y; Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, China., Zhang YJ; Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, China., Tu GW; Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, China., Hou JY; Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, China., Ma GG; Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, China., Hao GW; Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, China., Xu RH; Department of Mathematics, Halicioglu Data Science Institute, University of California, San Diego, La Jolla, California., Luo Z; Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Key Laboratory of Lung Inflammation and Injury, Shanghai, China; Department of Critical Care Medicine, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China. Electronic address: luo.zhe@zs-hospital.sh.cn.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2024 Feb; Vol. 117 (2), pp. 432-438. Date of Electronic Publication: 2023 Jul 23.
DOI:	10.1016/j.athoracsur.2023.07.011
Abstrakt:	Background: As patients with acute kidney injury (AKI) progress to a higher stage, the risk for poor outcomes dramatically rises. Early identification of patients at high risk for AKI progression remains a major challenge. This study aimed to evaluate the value of furosemide responsiveness (FR) for predicting AKI progression in patients with initial mild and moderate AKI after cardiac surgery. Methods: We performed 2 separate exploratory analyses. The Zhongshan cohort was a single-center, prospective, observational cohort, whereas the Beth Israel Deaconess Medical Center cohort was a single-center, retrospective cohort. We calculated 2 FR parameters for each patient, namely the FR index and modified FR index, defined as 2-hour urine output divided by furosemide dose (FR index, mL/mg/2 h) and by furosemide dose and body weight (modified FR index, mL/[mg·kg]/2 h), respectively. The primary outcome was AKI progression within 7 days. Results: AKI progression occurred in 80 (16.0%) and 359 (11.3%) patients in the Zhongshan and Beth Israel Deaconess Medical Center cohorts, respectively. All FR parameters (considered continuously or in quartiles) were inversely associated with risk of AKI progression in both cohorts (all adjusted P < .01). The addition of FR parameters significantly improved prediction for AKI progression based on baseline clinical models involving C-index, net reclassification improvement, and integrated discrimination improvement index in both cohorts (all P < .01). Conclusions: FR parameters were inversely associated with risk of AKI progression in patients with mild and moderate AKI after cardiac surgery. The addition of FR parameters significantly improved prediction for AKI progression based on baseline clinical models. (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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