Congenital heart surgery in infants: Effects of acute kidney injury on outcomes

Joshua J. Blinder, Stuart L. Goldstein, Vei Vei Lee, Alixandra Baycroft, Charles D. Fraser, David Nelson, John Jefferies

Research output: Contribution to journalArticle

182 Citations (Scopus)

Abstract

Objectives: We sought to characterize factors and outcomes associated with postoperative acute kidney injury in infants undergoing cardiac surgery. Methods: We retrospectively studied 430 infants (<90 days) who underwent heart surgery for congenital defects. With a pediatric modified version of the Acute Kidney Injury Network classification, we performed statistical analyses to detect factors and outcomes associated with postoperative acute kidney injury. Results: Postoperative acute kidney injury occurred in 225 patients (52%): 135 patients (31%) reached maximum acute kidney injury stage I, 59 (14%) reached stage II, and 31 (7%) reached stage III. On multivariable analysis, single-ventricle status (odds ratio, 1.6; 95% confidence interval, 1.08-2.37; P = .02), cardiopulmonary bypass (odds ratio, 1.2; 95% confidence interval 1.01-1.47; P = .04), and higher reference serum creatinine (odds ratio, 5.1; 95% confidence interval, 1.94-13.2; P = .0009) were associated with postoperative acute kidney injury. Thirty-two (7%) patients died in the hospital. Multivariable logistic regression showed that more severe acute kidney injury was associated with in-hospital mortality (maximum acute kidney injury stage II odds ratio, 5.1; 95% confidence interval, 1.7-15.2; P = .004; maximum acute kidney injury stage III odds ratio, 9.46; 95% confidence interval, 2.91-30.7; P = .0002) and longer mechanical ventilation and inotropic support. All acute kidney injury stages were associated with longer intensive care durations. Stage III acute kidney injury was associated with systemic ventricular dysfunction at hospital discharge. Conclusions: Perioperative acute kidney injury is common in infant heart surgery and portends a poor clinical outcome.

Original languageEnglish (US)
Pages (from-to)368-374
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume143
Issue number2
DOIs
StatePublished - Feb 1 2012
Externally publishedYes

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Acute Kidney Injury
Thoracic Surgery
Odds Ratio
Confidence Intervals
Ventricular Dysfunction
Critical Care
Hospital Mortality
Cardiopulmonary Bypass
Artificial Respiration
Creatinine
Logistic Models
Pediatrics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Congenital heart surgery in infants : Effects of acute kidney injury on outcomes. / Blinder, Joshua J.; Goldstein, Stuart L.; Lee, Vei Vei; Baycroft, Alixandra; Fraser, Charles D.; Nelson, David; Jefferies, John.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 143, No. 2, 01.02.2012, p. 368-374.

Research output: Contribution to journalArticle

Blinder, Joshua J. ; Goldstein, Stuart L. ; Lee, Vei Vei ; Baycroft, Alixandra ; Fraser, Charles D. ; Nelson, David ; Jefferies, John. / Congenital heart surgery in infants : Effects of acute kidney injury on outcomes. In: Journal of Thoracic and Cardiovascular Surgery. 2012 ; Vol. 143, No. 2. pp. 368-374.
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