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Urine Output During Cardiopulmonary Bypass Predicts Acute Kidney Injury After Cardiac Surgery: A Single-Center Retrospective Analysis.

 Young Song  ;  Dong Wook Kim  ;  Young Lan Kwak  ;  Beom Seok Kim  ;  Hyung Min Joo  ;  Jin Woo Ju  ;  Young Chul Yoo 
 MEDICINE, Vol.95(22) : 3757, 2016 
Journal Title
Issue Date
Acute Kidney Injury/epidemiology* ; Acute Kidney Injury/etiology ; Acute Kidney Injury/physiopathology ; Cardiac Surgical Procedures/adverse effects* ; Cardiopulmonary Bypass/adverse effects* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Odds Ratio ; Postoperative Complications/epidemiology* ; Postoperative Complications/etiology ; Postoperative Complications/physiopathology ; ROC Curve ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Urodynamics/physiology*
Urine output is closely associated with renal function and has been used as a diagnostic criterion for acute kidney injury (AKI). However, urine output during cardiopulmonary bypass (CPB) has never been identified as a predictor of postoperative AKI. Considering altered renal homeostasis during CPB, we made a comprehensible approach to CPB urine output and evaluated its predictability for AKI.Patients undergoing cardiovascular surgery with the use of CPB, between January 2009 and December 2011, were retrospectively reviewed. AKI was defined as an increase in serum creatinine ≥0.3 mg/dL in the first postoperative 48 hours. We extrapolated a possible optimal amount of urine output from the plot of probability of AKI development according to CPB urine output. After separating patients by the predicted optimal value, we performed stepwise logistic regression analyses to find potential predictors of AKI in both subgroups.A total of 696 patients were analyzed. The amount of CPB urine output had a biphasic association with the incidence of AKI using 4 mL/kg/h as a boundary value. In a multivariate logistic regression to find predictors for AKI in entire patients, CPB urine output did not show statistical significance. After separating patients into subgroups with CPB urine output below and over 4 mL/kg/h, it was identified as an independent predictor for AKI with the odds ratio of 0.43 (confidence interval 0.30-0.61) and 1.11 (confidence interval 1.02-1.20), respectively.The amount of urine output during CPB with careful analysis may serve as a simple and feasible method to predict the development of AKI after cardiac surgery at an early time point.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Kim, Beom Seok(김범석) ORCID logo https://orcid.org/0000-0002-5732-2583
Song, Young(송영) ORCID logo https://orcid.org/0000-0003-4597-387X
Yoo, Young Chul(유영철) ORCID logo https://orcid.org/0000-0002-6334-7541
Ju, Jin Wu(주진우)
Joo, Hyung Min(주형민)
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