ObjectiveTo investigate the incidence of acute kidney injury (AKI) after deep hypothermic circulatory arrest (DHCA), to explore the risk factors and prognosis of postoperative AKI, and to establish a relatively accurate preoperative risk assessment strategy and prevention measures.MethodsThe clinical data of 252 patients who underwent deep hypothermic circulatory surgery in our hospital from January 2014 to October 2018 were retrospectively analyzed. There were 179 males and 73 females with an average age of 53.6±11.6 years. The patients were divided into an AKI group and a non-AKI group according to the AKI diagnostic criteria developed by kidney disease improving global outcomes (KDIGO). The data of the two groups were compared, and the risk factors related to AKI after DHCA were analyzed by single factor and multivariate logistic regression.ResultsAmong the 252 patients enrolled, the incidence of AKI was 69.0%. The postoperative hospital mortality rate was 7.9% (20/252). The univariate analysis showed that the patient's age and body mass index (BMI)≥28 kg/m2, left ventricular ejection fraction<55%, preoperative serum creatinine (Scr)≥110 μmol/L, preoperative estimated glomerular filtration rate (eGFR), Cleveland score and intraoperative cardiopulmonary bypass time, intraoperative infusion of red blood cells, intraoperative infusion of plasma, postoperative mechanical ventilation time≥40 h and other indicators were significantly different between the two groups (P<0.05); multivariate logistic regression analysis showed that there was significant difference between the two groups in age (OR=1.040, 95% CI 1.017–1.064, P=0.001), BMI≥28 kg/m2 (OR=2.335, 95%CI 1.093–4.990, P=0.029), eGFR<90 mL/(min·1.73 m2) (OR=2.044, 95%CI 1.082–3.863, P=0.028), preoperative Cleveland score (OR=1.300, 95%CI 1.054–1.604, P=0.014) and intraoperative cardiopulmonary bypass time (OR=1.009, 95%CI 1.002–1.017, P=0.014).ConclusionThe incidence of AKI is higher after DHCA. Patients with postoperative AKI have longer hospital stay and higher risk of hospitalization death. The age of patients, BMI≥28 kg/m2, eGFR<90 mL/(min·1.73) m2, Cleveland score, intraoperative extracorporeal circulation time are independent risk factors for AKI after DHCA.
Objective To investigate the early diagnostic value of urinary neutrophil gelatinase-associated lipocalin (NGAL) for acute kidney injury (AKI) after acute Stanford type A aortic dissection. Methods From January 2018 to December 2018, the clinical data of 50 patients who underwent open surgery for acute Stanford type A aortic dissection were analyzed in Nanjing First Hospital. Urine specimens were collected before and 2 hours after the aortic dissection surgery. Patients were divided into an AKI group (n=27) and a non-AKI group (n=23) according to the Kidney Disease Improving Global Outcomes criteria. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of urine NGAL. ResultsThe incidence of postoperative AKI was 54.00% (27/50). There was a statistically significant difference between the two groups in serum creatinine concentration at 2 hours after surgery and urinary NGAL concentration before the surgery (P<0.05). The area under ROC curve of preoperative urinary NGAL concentration was 0.626. When cut-off value was 43 ng/mL, the sensitivity was 40.7%, specificity was 95.7%. The area under ROC curve of urinary NGAL concentration at 2 hours after surgery was 0.655, and when the cut-off value was 46.95 ng/mL, the sensitivity was 63.0%, specificity was 78.3%. Conclusion Urine NGAL can predict postoperative AKI in patients with acute Stanford type A aortic dissection, but its value is limited.
Objective To evaluate the efficacy and safety of nafamostat mesylate as an in vitro anticoagulant in continuous renal replacement therapy (CRRT) using oXiris filters for patients with sepsis-associated acute kidney injury (SA-AKI). Methods SA-AKI patients at high risk of bleeding who received oXiris filter-CRRT at West China Hospital of Sichuan University between November 2021 and January 2023 were included in the study. Patients who received nafamostat mesylate as an anticoagulant were categorized into the nafamostat group, while patients who did not receive any anticoagulant during the same period were categorized into the control group. A comparative analysis was conducted between the two groups regarding general conditions, the lifespan of the first filter in CRRT, the number and percentage of cases with the first filter lasting 24, 48, and 72 h, activated clotting time (ACT) before and during treatment (both pre-filter and post-filter), laboratory test results before and after treatment, incidence of adverse reactions during treatment, and clinical outcomes of the patients. The mean ± standard deviation was used for normal distribution, and the median (lower quartile, upper quartile) was used for non-normal distribution. Results A total of 118 patients were included in the study, with 90 in the control group and 28 in the nafamostat group. There was no statistically significant difference in the general conditions or pre-treatment laboratory test indicators between the two groups (P>0.05). Kaplan-Meier survival analysis showed that the lifespan of the first filter was longer in the nafamostat group compared to the control group (hazard ratio=0.524, P=0.001). The percentage of patients whose first filter lasted 24 h was higher in the nafamostat group than that in the control group (60.7% vs. 25.7%, P=0.001); however, there was no statistically significant difference between the two groups for the first filter lasting 48 h or 72 h (P>0.05). During CRRT treatment, the mean post-filter ACT was longer in the nafamostat group than that in the control group [(216.7±43.2) vs. (181.6±35.5) s, P<0.001], and the mean post-filter ACT was longer than the pre-filter ACT in the nafamostat group [(216.7±43.2) vs. (183.3±37.7) s, P=0.005]. After the treatment, the international normalized ratio [1.5 (1.1, 1.8) vs. 1.7 (1.4, 2.4)], interleukin-6 levels [(235.5±80.9) vs. (500.5±112.7) pg/mL] were lower, and platelet count [48.0 (31.8, 73.0)×109/L vs. 29.0 (11.0, 61.8)×109/L] was higher in the nafamostat group compared to the control group (P<0.05). There was no statistically significant difference in other laboratory test indicators (P>0.05). The clinical outcomes of the patients did not show statistically significant difference between the two groups (P>0.05). Conclusion Nafamostat mesilate may be an effective and safe anticoagulant in SA-AKI patients at high risk of bleeding underwent oXiris filter-CRRT, and its in vitro anticoagulant effect is better than that without anticoagulant.