| Objective:To investigate the relationship between the changes of renal regional oxygen saturation(RrSO2),renal resistive index(RRI),serum cystatin C(sCysC),estimate glomerular filtration rate based on cystatin C(eGFR-CysC)and Cardiac surgery-associated acute kidney injury(CSA-AKI)Methods:A prospective clinical observation study was conducted,and 68 cases of cardiac surgery patients who met the admission criteria were included in East Hospital from April 2019 to October 2019.For the participants,RrSO2 and RRI were measured before surgery and 1h,8h,24h,and 48h after surgery,sCysC and eGFR-CysC were measured before surgery and 24h and 48h after surgery,serum creatinine(Scr)and estimate glomerular filtration rate based on serum creatinine(eGFR-Scr)were monitored daily for 7 days after operation,and urine volume was recorded per hour after surgery.According to the Kidney Disease:Improving Global Outcomes Guide(KDIGO)AKI diagnostic criteria,the participants were divided into CSA-AKI group(n=13)and non CSA-AKI patients(n=55),and dynamic changes of RrSO2,RRI,sCysC,eGFR-CysC,Scr and urine volume after operation were observed.The receiver operating characteristic curve(ROC curve)was used to determine the best prediction time of RrSO2,RRI,sCysC,eGFR-CysC,and the areas under the curve between different time points of the same indicator and at the same time point of different indicators were compared RrSO2,RRI were combined to analysis diagnostic performance,and compared with RrSO2,RRI alone diagnosis;The effectiveness of ΔRrSO2 and ΔRRI as diagnostic markers for CSA-AKI patients was evaluated.Statistical analysis:Using SPSS 19.0 and MedCalc for statistical analysis.The measurement data of normal distribution was expressed as mean ±standard deviation((?)±S).The independent sample t test was used to compare the two groups.the Z test was used to compare the areas under the ROC curve.P<0.05 was considered statistically significant for all statistical processes.Results:The ROC curves of RrSO2 and RRI for CSA-AKI diagnosis were plotted before and 1h,8h,24h,and 48h after surgery.The areas under the RrSO2 curve were:0.588,0.725,0.718,0.729,0.745,and the areas under the RRI curve were:0.592,0.752,0.692,0.729,0.740.The areas under the ROC curve by RrSO2,RRI at each time point after surgery were significantly greater than 0.5.There were no significant statistical difference in the areas under the curve of RrSO2 and RRI at the same index at different time points and at the same time point for different indicators;There were no significant difference in the areas under the RrSO2,RRI combined curve and the areas under the RrSO2,RRI alone diagnostic curve at each time point after surgery.The ROC curves of sCysC and eGFR-CysC for CSA-AKI diagnosis were plotted before and 24h,48h after surgery.The areas under the sCysC curve were:0.758,0.839,and 0.922,and the areas under the eGFR-CysC curve were:0.820,0.891,0.944.The areas under the curve at each time point before and after surgery were significantly greater than 0.5.There were no significant difference in the areas of sCysC and eGFR-CysC for the same index at different time points and at the same time point for different indicators.The difference between the areas under the eGFR-CysC curve and the areas under the RrSO2 curve at 24h and 48h after operation were statistically significant(P<0.05).The ROC curves of ΔRrSO2 and ΔRRI for CSA-AKI diagnosis were plotted at 1h,8h,24h,and 48h after surgery.The areas under the ΔRrSO2 curve were:0.821,0.792,0.738,and 0.794.The areas under the curve at each time point of ΔRrSO2 were significantly greater than 0.5.There were no significant difference in the areas under the curve for the same index at different time points;There were no significant difference in the areas under the ROC curve of △RrSO2 and the areas under the ROC curve of RrSO2 at corresponding time points after surgery.The areas under the ΔRRI curve are:0.780,0.652,0.653,and 0.657.Only after 1h,the area under the curve is significantly greater than 0.5.At this time,the optimal threshold is 0.159 and the Yoden index is 0.587Conclusion:1.RrSO2,RRI,sCysC,eGFR-CysC can be used for early diagnosis of CSA-AKI after cardiac surgery2.The combined diagnostic efficacy of RrSO2 and RRI at each time point was not significantly higher than that of RrSO2 and RRI alone3.SCysC and eGFR-CysC levels before and after cardiac surgery can be used for early diagnosis of CSA-AKI.The diagnostic efficacy of eGFR-CysC is better than RrSO2 at 24h and 48h after cardiac surgery4.ΔRrSO2 at various time points after cardiac surgery can predict the occurrence of CSA-AKI,which is equivalent to the diagnostic efficacy of RrSO2 at corresponding time points. |
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