Structural equation modelling exploration of the key pathophysiological processes involved in cardiac surgery-related acute kidney injury in infants.
Details
State: Public
Version: Final published version
Serval ID
serval:BIB_5A759DF76175
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Structural equation modelling exploration of the key pathophysiological processes involved in cardiac surgery-related acute kidney injury in infants.
Journal
Critical care
ISSN
1466-609X (Electronic)
ISSN-L
1364-8535
Publication state
Published
Issued date
05/06/2016
Peer-reviewed
Oui
Volume
20
Number
1
Pages
171
Language
english
Notes
Publication types: Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Publication Status: epublish
Abstract
Uncertainties about the pathophysiological processes resulting in cardiac surgery-related acute kidney injury (AKI) in infants concern the relative impact of the most prominent risk factors, the clinical relevance of changes in glomerular filtration rate vs tubular injury, and the usefulness of available diagnostic tools. Structural equation modelling could allow for the assessment of these complex relationships.
A structural model was specified using data from a prospective observational cohort of 200 patients <1 year of age undergoing cardiopulmonary bypass surgery. It included four latent variables: AKI, modelled as a construct of perioperative creatinine variation, of oliguria and of urine neutrophil gelatinase-associated lipocalin (uNGAL) concentrations; the cardiopulmonary bypass characteristics; the occurrence of a post-operative low cardiac output syndrome and the post-operative outcome.
The model showed a good fit, and all path coefficients were statistically significant. The bypass was the most prominent risk factor, with a path coefficient of 0.820 (95 % CI 0.527-0.979), translating to a 67.2 % explanation for the risk of AKI. A strong relationships was found between AKI and early uNGAL excretion, and between AKI and the post-operative outcome, with path coefficients of 0.611 (95 % CI 0.347-0.777) and 0.741 (95 % CI 0.610-0.988), respectively. The path coefficient between AKI and a >50 % increase in serum creatinine was smaller, with a path coefficient of 0.443 (95 % CI 0.273-0.596), and was intermediate for oliguria, defined as urine output <0.5 ml kg(-1) h(-1), with a path coefficient of 0.495 (95 % CI 0.250-0.864). A path coefficient of -0.229 (95 % CI -0.319 to 0.060) suggested that the risk of AKI during the first year of life did not increase with younger age at surgery.
These findings suggest that cardiac surgery-related AKI in infants is a translation of tubular injury, predominately driven by the cardiopulmonary bypass, and linked to early uNGAL excretion and to post-operative outcome.
ClinicalTrials.gov identifier NCT01219998 . Registered 11 October 2010.
A structural model was specified using data from a prospective observational cohort of 200 patients <1 year of age undergoing cardiopulmonary bypass surgery. It included four latent variables: AKI, modelled as a construct of perioperative creatinine variation, of oliguria and of urine neutrophil gelatinase-associated lipocalin (uNGAL) concentrations; the cardiopulmonary bypass characteristics; the occurrence of a post-operative low cardiac output syndrome and the post-operative outcome.
The model showed a good fit, and all path coefficients were statistically significant. The bypass was the most prominent risk factor, with a path coefficient of 0.820 (95 % CI 0.527-0.979), translating to a 67.2 % explanation for the risk of AKI. A strong relationships was found between AKI and early uNGAL excretion, and between AKI and the post-operative outcome, with path coefficients of 0.611 (95 % CI 0.347-0.777) and 0.741 (95 % CI 0.610-0.988), respectively. The path coefficient between AKI and a >50 % increase in serum creatinine was smaller, with a path coefficient of 0.443 (95 % CI 0.273-0.596), and was intermediate for oliguria, defined as urine output <0.5 ml kg(-1) h(-1), with a path coefficient of 0.495 (95 % CI 0.250-0.864). A path coefficient of -0.229 (95 % CI -0.319 to 0.060) suggested that the risk of AKI during the first year of life did not increase with younger age at surgery.
These findings suggest that cardiac surgery-related AKI in infants is a translation of tubular injury, predominately driven by the cardiopulmonary bypass, and linked to early uNGAL excretion and to post-operative outcome.
ClinicalTrials.gov identifier NCT01219998 . Registered 11 October 2010.
Keywords
Acute Kidney Injury/etiology, Acute Kidney Injury/physiopathology, Biomarkers/analysis, Biomarkers/urine, Cardiac Surgical Procedures/adverse effects, Cardiac Surgical Procedures/mortality, Cardiac Surgical Procedures/statistics & numerical data, Cardiopulmonary Bypass/adverse effects, Cardiopulmonary Bypass/statistics & numerical data, Creatinine/analysis, Creatinine/urine, Extracorporeal Membrane Oxygenation/methods, Female, France, Humans, Infant, Newborn, Lipocalin-2/analysis, Lipocalin-2/urine, Male, Pediatrics/statistics & numerical data, Pediatrics/trends, Peritoneal Dialysis/methods, Postoperative Complications/etiology, Postoperative Complications/mortality, Risk Factors, Acute kidney injury, Cardiopulmonary bypass, Paediatric cardiac surgery
Pubmed
Web of science
Open Access
Yes
Create date
09/03/2018 18:43
Last modification date
20/08/2019 15:13
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