대동맥 축착과 대혈관 전위 진단 하 개심술을 받는 영아에서 수술 후 급성신손상 발생의 위험 인자에 대한 후향적 코호트 연구

Abstract

Background: The incidence of acute kidney injury (AKI) in pediatric cardiac patients is high and postoperative AKI is associated with increased morbidity and mortality. The purpose of this study was to investigate risk factors for postoperative AKI in infants undergoing surgery for coarctation of the aorta (COA) and transposition of the great arteries (TGA). Methods: This was a single-center, retrospective cohort study of 399 infants who underwent primary total correction for COA and TGA at Asan Medical Center from January 2005 to December 2015. We employed multivariable logistic regression analysis to determine risk factors for AKI. Results: One hundred and one patients (55%) in the COA group and 133 patients (62%) in the TGA group developed AKI as defined by the Kidney Disease Improving Global Outcome criteria. In the COA group, the only variables independently associated with postoperative AKI were preoperative hypoalbuminemia (Odds ratio (OR), 2.468; 95% Confidence interval (CI), 1.269 – 4.800; P = 0.008), intraoperative maximum vasoactive-inotropic score (VIS) (OR, 1.054; 95% CI, 1.002 – 1.109; P = 0.040) and birth weight (OR, 0.999; 95% CI, 0.998 – 1.00; P =0.002). In the TGA group, the independent risk factors for postoperative AKI included intraoperative maximum VIS (OR, 1.034; 95% CI, 1.004 – 1.065; P = 0.025) and aortic cross-clamp time (OR, 1.015; 95% CI, 1.004 – 1.025; P = 0.006). Conclusions: We determined different perioperative variables in each group as independent risk factors for postoperative AKI, emphasizing the importance of delicate and individualized anesthetic management in pediatric cardiac patients.

Keyword: acute kidney injury, risk factors, aortic coarctation, transposition of great vessels, infant