Abstract:
PURPOSE:Acute kidney injury (AKI) frequently occurs after heart transplantation (HTx), but its relation to preoperative right heart hemodynamic (RHH) parameters remains unknown. Therefore, we aimed to determine their predictive properties for postoperative AKI severity within 30 days after HTx. METHODS:From 1984 to 2016, all consecutive HTx recipients (n = 595) in our tertiary referral center were included and analyzed for the occurrence of postoperative AKI staged by the kidney disease improving global outcome criteria. The effects of preoperative RHH parameters on postoperative AKI were calculated using logistic regression, and predictive accuracy was assessed using integrated discrimination improvement (IDI), net reclassification improvement (NRI), and area under the receiver operating characteristic curves (AUC). RESULTS:Postoperative AKI occurred in 430 (72%) patients including 278 (47%) stage 1, 66 (11%) stage 2, and 86 (14%) stage 3 cases. Renal replacement therapy (RRT) was administered in 41 (7%) patients. Patients with higher AKI stages had also higher baseline right atrial pressure (RAP; median 7, 7, 8, and in RRT 11 mmHg, p trend = 0.021), RAP-to-pulmonary capillary wedge pressure ratio (median 0.37, 0.36, 0.40, 0.47, p trend = 0.009), and lower pulmonary artery pulsatility index (PAPi) values (median 2.83, 3.17, 2.54, 2.31, p trend = 0.012). Higher RAP and lower PAPi values independently predicted AKI severity [adjusted odds ratio (OR) per doubling of RAP 1.16 (1.02-1.32), p = 0.029; of PAPi 0.85 (0.75-0.96), p = 0.008]. Based on IDI, NRI, and delta AUC, inclusion of these parameters improved the models' predictive accuracy. CONCLUSIONS:Preoperative PAPi and RAP strongly predict the development of AKI early after HTx and can be used as early AKI predictors.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Guven G,Brankovic M,Constantinescu AA,Brugts JJ,Hesselink DA,Akin S,Struijs A,Birim O,Ince C,Manintveld OC,Caliskan Kdoi
10.1007/s00134-018-5159-zsubject
Has Abstractpub_date
2018-05-01 00:00:00pages
588-597issue
5eissn
0342-4642issn
1432-1238pii
10.1007/s00134-018-5159-zjournal_volume
44pub_type
杂志文章abstract:PURPOSE:To determine the oxygen affinity for optimal tissue oxygen delivery with a hemoglobin-hydroxyethyl starch conjugate (HRC 101). METHODS:Anesthetized rats were hemodiluted (180 ml kg(-1)) with low (P(50) approximately 70 mmHg) or high affinity (P(50) approximately 14 mmHg) HRC 101 at hemoglobin (Hb) concentratio...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-009-1532-2
更新日期:2009-11-01 00:00:00
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journal_title:Intensive care medicine
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pub_type: 杂志文章,多中心研究
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更新日期:2009-02-01 00:00:00
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pub_type: 临床试验,杂志文章
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更新日期:2004-09-01 00:00:00
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更新日期:2006-05-01 00:00:00
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journal_title:Intensive care medicine
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更新日期:1991-01-01 00:00:00
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更新日期:2000-12-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章,评审
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pub_type: 杂志文章,评审
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更新日期:2010-08-01 00:00:00
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更新日期:2002-05-01 00:00:00
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更新日期:2014-09-01 00:00:00