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2016 ; 20
(1
): 171
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English Wikipedia
Structural equation modelling exploration of the key pathophysiological processes
involved in cardiac surgery-related acute kidney injury in infants
#MMPMID27262736
Bojan M
; Basto Duarte MC
; Ermak N
; Lopez-Lopez V
; Mogenet A
; Froissart M
Crit Care
2016[Jun]; 20
(1
): 171
PMID27262736
show ga
BACKGROUND: Uncertainties about the pathophysiological processes resulting in
cardiac surgery-related acute kidney injury (AKI) in infants concern the relative
impact of the most prominent risk factors, the clinical relevance of changes in
glomerular filtration rate vs tubular injury, and the usefulness of available
diagnostic tools. Structural equation modelling could allow for the assessment of
these complex relationships. METHODS: A structural model was specified using data
from a prospective observational cohort of 200 patients <1 year of age undergoing
cardiopulmonary bypass surgery. It included four latent variables: AKI, modelled
as a construct of perioperative creatinine variation, of oliguria and of urine
neutrophil gelatinase-associated lipocalin (uNGAL) concentrations; the
cardiopulmonary bypass characteristics; the occurrence of a post-operative low
cardiac output syndrome and the post-operative outcome. RESULTS: The model showed
a good fit, and all path coefficients were statistically significant. The bypass
was the most prominent risk factor, with a path coefficient of 0.820 (95 % CI
0.527-0.979), translating to a 67.2 % explanation for the risk of AKI. A strong
relationships was found between AKI and early uNGAL excretion, and between AKI
and the post-operative outcome, with path coefficients of 0.611 (95 % CI
0.347-0.777) and 0.741 (95 % CI 0.610-0.988), respectively. The path coefficient
between AKI and a >50 % increase in serum creatinine was smaller, with a path
coefficient of 0.443 (95 % CI 0.273-0.596), and was intermediate for oliguria,
defined as urine output <0.5 ml kg(-1) h(-1), with a path coefficient of 0.495
(95 % CI 0.250-0.864). A path coefficient of -0.229 (95 % CI -0.319 to 0.060)
suggested that the risk of AKI during the first year of life did not increase
with younger age at surgery. CONCLUSIONS: These findings suggest that cardiac
surgery-related AKI in infants is a translation of tubular injury, predominately
driven by the cardiopulmonary bypass, and linked to early uNGAL excretion and to
post-operative outcome. TRIAL REGISTRATION: ClinicalTrials.gov identifier
NCT01219998 . Registered 11 October 2010.