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Minerva Anestesiologica 2020 Jul 02

DOI: 10.23736/S0375-9393.20.14460-2


lingua: Inglese

The predictive value of the intraoperative renal pulsatility index for acute kidney injury in patients undergoing cardiac surgery

Hui ZHANG, Kang ZHOU, Dongyue WANG, Na ZHANG, Jindong LIU

Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China


BACKGROUND: The incidence of cardiac surgery-associated acute kidney injury (CSA-AKI) is very high. The renal resistive index (RRI) is measured by transesophageal echocardiography (TEE) and can be used to predict the occurrence of CSA-AKI, but few studies have examined the renal pulsatility index (RPI). The objective of this study was to explore the predictive value of intraoperative RPI for CSA-AKI.Error! Reference source not found.
METHODS: This study was a prospective observational study. Seventy-eight patients meeting the inclusion criteria were enrolled. The RPI was measured by TEE after the induction of general anaesthesia (T1) and immediately after the surgery (T2). Serum creatinine (Scr) was measured 1 day before and 7 days after the surgery. The diagnosis of AKI was based on the KDIGO diagnostic criteria. Multivariate logistic regression analysis was used to analyse the risk factors for postoperative AKI and to draw the receiver operating characteristic curve (ROC) and analyse its diagnostic value for AKI.
RESULTS: The incidence of postoperative AKI was 29.5%. The RPI at T2 was higher in the AKI group than in the non-AKI group (2.05±0.69 versus 1.49±0.48, P< 0.001). The results of multivariate analysis showed that the RPI at T2 was an independent risk factor for the occurrence of AKI (OR=4.683, 95% CI: 1.592-13.772; P=0.006). The area under the curve (AUC) of the RPI was 0.733 (95% CI: 0.621-0.827) with a cut-off value of 1.86 (sensitivity 60.87%, specificity 85.45% and Youden index 0.46).
CONCLUSIONS: A RPI at T2 > 1.86 is correlated with a higher incidence of postoperative AKI. Treatment guided and personalized on the base of this parameter should be investigated by further dedicated studies.

KEY WORDS: Renal pulsatile index; Acute renal injury; Cardiopulmonary bypass; Transesophageal echocardiography; Cardiac surgery

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