Clinical Research On Acute Kidney Injury After Pediatric Congenital Heart Surgery

Incidence of congenital heart diseases reached 9‰ to 2014 already according to statistics.Surgery is the main treatment,but after which acute kidney injury(AKI)as one of the severe complications is common with incidence of 5~33%.For severe AKI,treatment could not be effective enough so far.As a result,early prevention and diagnosis are very crucial to decrease the incidence and severity of AKI,and helpful to decrease mechanical ventilation duration,intensive care unit stay,hospital stay and mortality,thus improving prognosis of patients.AKI after congenital heart surgery is getting more attention from researchers,but among congenital heart diseases patients,children is a group which has its own characteristics.Compared to adults,after birth,younger children are still in the developing process of renal function that they have higher risk of getting AKI after surgery.So we choose children below 4 years old as our subject to study on the characteristics of AKI after congenital heart surgery.1.Risk factors of AKI after pediatric congenital heart surgeryIt is imperative to recognize children at high risk of AKI after surgery for early prevention and diagnosis.And research on risk factors of AKI after pediatric congenital heart surgery could help doctors to recognize these patients and take measures to decrease incidence of AKI,thus improving prognosis.Because of difference in institutions patients were from,factors that were analyzed,and also age of subjects as the most possible reason,results of domestic and foreign researches differ.Due to developing renal function,lower aged patients are at higher risk of AKI after pediatric congenital heart surgery,so this time we chose subjects below 4 years old to study.Objective: To analyze the risk factors of AKI after pediatric congenital heart surgery among children aged younger than 4 years old.Method: With clinical materials of children aged younger than 4 years old after pediatric congenital heart surgery in Xinqiao hospital during April,2015 to April,2016,we used modified pRIFLE score to diagnosis AKI and calculated the incidence of AKI,compared the difference between AKI group and N-AKI group,and screened the clinical risk factors of AKI after pediatric congenital heart surgery.Result: Of the 298 patients included,AKI occurred in 107(35.91%),within which 82(27.52%)attained at risk stage,16(5.37%)injury stage,and 9(3.02%)failure stage.Compared with N-AKI group,children with AKI had lower age,height,weight,Scr,larger cyanosis and comorbidity ratio,and higher ASA classification before surgery,had longer duration of surgery,cardiac pulmonary bypass(CPB)time,aortic clamping time(ACT)in surgery,and had higher level of Urea,Ua,Scr,CystC,RBP,lower estimated creatinine clearance(eCCl),longer hospital stay and higher mortality after surgery.Logistic regression analysis showed that under the age of 1 year,cynosis,lower pre-surgery Scr,longer duration of surgery were the independent risk factors of AKI.Conclusion: Patients with age under 1 year old,a history of cynosis,and lower pre-surgery Scr are at higher risk of getting AKI after pediatric congenital heart surgery.And also longer duration of surgery could significantly increase the risk.2.Impact of fluid balance on AKI diagnosis and hospital stay of pediatric patients after congenital heart surgeryMeasuerd Scr is affected by age,muscle mass and quality,protein catabolic rate,renal function,cardiac output,and fluid volume.During hospital stay,from the beginning of surgery to ICU stay after surgery,patients' fluid balance fluctuates because of surgical and fluid treatment.Thus,influenced by fluid volume,measured Scr could also fluctuate after surgery.So here is the question,will fluid balance impact the diagnosis of AKI and patients prognosis by influencing measured Scr ? Using simple formula to correct Scr,we researched on the impact of fluid balance corrected Scr on the diagnosis of AKI,and compared the hospital stay of new AKI or N-AKI to other patients as a prognostic indicator to see if fluid balance impact on the hospital stay after pediatric congenital heart surgery by changing the diagnosis of AKI.Objective: To study the influence of fluid balance on AKI diagnosis and patients hospital stay after pediatric congenital heart surgery.Method: After collecting the data of pediatric congenital heart surgery patients hospitalized in Xinqiao hospital from April,2015 to April,2016,we analyzed the difference of AKI incidence before and after fluid balance corrected Scr with pRIFLE score.After fluid balance corrected Scr,we also used multivariate step linear regression,removing the interference of other factors like age,NYHA score,commodities,and RACHS-1 score,to analyze the hospital stay difference between new AKI or N-AKI patients and other patients,to see if fluid balance by changing diagnosis influence the hospital stay after pediatric congenital heart surgery.Result: After positive fluid balance adjusting Scr,AKI incidence of 169 patients is higher;After negative fluid balance adjusting Scr,AKI incidence of 117 patients is lower;On the whole sample of 286 pediatric patients level,fluid balance adjusted Scr didn't impacted on incidence of AKI;Multivariate step linear regression showed no difference between new AKI or N-AKI patients and other patients on hospital stay.Conclusion: After positive fluid balance adjusting Scr,AKI incidence of patients is higher,positive fluid balance delays the recognition of AKI;After negative fluid balance adjusting Scr,AKI incidence patients is lower;Fluid balance will not impact on hospital stay of pediatric congenital heart surgery patients by changing the diagnosis of AKI.