Investigating preoperative myoglobin level as predictive factor for acute kidney injury following cardiac surgery with cardiopulmonary bypass: a retrospective observational study
Investigando o nível de mioglobina pré-operatório como fator preditivo de lesão renal aguda após cirurgia cardíaca com circulação extracorpórea: um estudo observacional retrospectivo
Kuen Su Lee, Hyun Joong Kim, Yoon Sook Lee, Yoon Ji Choi, Sang Min Yoon, Woon Young Kim, Jae Hwan Kim
Abstract
Background
Early identification of patients at risk of AKI after cardiac surgery is of critical importance for optimizing perioperative management and improving outcomes. This study aimed to identify the association between preoperative myoglobin levels and postoperative acute kidney injury (AKI) in patients undergoing valve surgery or coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass.
Methods
This retrospective study included 293 patients aged over 17 years who underwent valve surgery or CABG with cardiopulmonary bypass. We excluded 87 patients as they met the exclusion criteria. Therefore, 206 patients were included in the final analysis. The patients’ demographics as well as intraoperative and postoperative data were collected from electronic medical records. AKI was defined according to the Acute Kidney Injury Network classification system.
Results
Of the 206 patients included in this study, 77 developed AKI. The patients who developed AKI were older, had a history of hypertension, underwent valve surgery with concomitant CABG, had lower preoperative hemoglobin levels, and experienced prolonged extracorporeal circulation (ECC) times. Multivariate logistic regression analysis revealed that preoperative myoglobin levels and ECC time were correlated with the development of AKI. A higher preoperative myoglobin level was an independent risk factor for the development of cardiac surgery-associated AKI.
Conclusions
Higher preoperative myoglobin levels may enable physicians to identify patients at risk of developing AKI and optimize management accordingly.
Keywords
Resumo
Introdução
A identificação precoce de pacientes com risco de LRA após cirurgia cardíaca é de fundamental importância para otimizar o manejo perioperatório e melhorar os resultados. Este estudo teve como objetivo identificar a associação entre os níveis de mioglobina pré-operatórios e lesão renal aguda (LRA) pós-operatória em pacientes submetidos a cirurgia valvar ou cirurgia de revascularização do miocárdio (CRM) com circulação extracorpórea.
Métodos
Este estudo retrospectivo incluiu 293 pacientes com idade superior a 17 anos submetidos à cirurgia valvar ou revascularização do miocárdio com circulação extracorpórea. Excluímos 87 pacientes por atenderem aos critérios de exclusão. Portanto, 206 pacientes foram incluídos na análise final. Os dados demográficos dos pacientes, bem como os dados intra e pós-operatórios foram coletados de prontuários eletrônicos. A LRA foi definida de acordo com o sistema de classificação Acute Kidney Injury Network.
Resultados
Dos 206 pacientes incluídos neste estudo, 77 desenvolveram LRA. Os pacientes que desenvolveram LRA eram mais velhos, tinham histórico de hipertensão, foram submetidos a cirurgia valvar com revascularização do miocárdio concomitante, apresentavam níveis de hemoglobina pré-operatórios mais baixos e apresentavam tempos prolongados de circulação extracorpórea (CEC). A análise de regressão logística multivariada revelou que os níveis pré-operatórios de mioglobina e o tempo de CEC estavam correlacionados com o desenvolvimento de LRA. Um nível mais elevado de mioglobina pré-operatória foi um fator de risco independente para o desenvolvimento de LRA associada à cirurgia cardíaca.
Conclusão
Níveis mais elevados de mioglobina pré-operatória podem permitir que os médicos identifiquem pacientes com risco de desenvolver LRA e otimizem o manejo adequadamente.
Palavras-chave
References
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Submitted date:
01/13/2021
Accepted date:
08/28/2021
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