Cardiac Surgery-associated Acute Kidney Injury Research Articles

Diagnostic accuracy of NT-proBNP to predict the incidence of CSA-AKI: A systematic review and meta-analysis.

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a severe complication following cardiac surgery. Early identification and diagnosis are critical. In this study, we aim to systematically assess the diagnostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) for CSA-AKI. The PubMed, Embase, Web of Science, and Cochrane Library databases were searched from January 1971 to October 2023 to identify prospective observational and retrospective observational studies. Data extraction and study screening were carried out independently by 2 authors. The methodological quality of the included studies was evaluated by the Quality Assessment of Diagnostic Accuracy Studies 2 standards, and all statistical analyses were conducted by Stata 15.0. Seven studies including 37,200 patients were identified. The pooled sensitivity of 0.67 (95% credible interval [CI] = 0.56-0.77), specificity of 0.55 (95% CI = 0.45-0.64), area under the summary receiver operating characteristic curve of 0.65 (95% CI = 0.60-0.69), positive likelihood ratio of 1.5 (95% CI = 1.2-1.8), negative likelihood ratio of 0.60 (95% CI = 0.46-0.79), and diagnostic odds ratio of 2 (95% CI = 2-4) suggested that patients with higher preoperative NT-proBNP levels (pg/mL) are at higher risk of developing acute kidney injury after cardiac surgery. However, NT-proBNP lacks sufficient sensitivity and specificity to reliably predict CSA-AKI. Our findings suggest that the diagnostic accuracy of NT-proBNP to predict the incidence of CSA-AKI is limited. However, we provide novel perspectives on the early detection of CSA-AKI biomarkers, and it is urgent to identify more precise and practical biomarkers for the early diagnosis of CSA-AKI.

Cardiac Surgery-Associated Acute Kidney Injury in Cardiopulmonary Bypass: A Focus on Sex Differences and Preventive Strategies.

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a high-risk complication with well-recognized increased morbidity and mortality after cardiac surgery attributable in large part to cardiopulmonary bypass (CPB) associated factors contributing to AKI including hemodilution, hypothermia, hypotension and exposure to artificial surfaces. These conditions disrupt the renal microcirculation and activate local and systemic inflammatory responses to non-pulsatile flow, and low perfusion pressure. The underlying mechanisms of CSA-AKI in CPB are not fully understood, and the incidence of CSA-AKI remains high at around 30%. Furthermore, women appear to be more vulnerable than men to the renal injury associated with CPB even though the overall incidence of cardiovascular and kidney diseases is lower in premenopausal women. Nevertheless, estrogen elicits renoprotective effects in several ways including mitigating inflammation, promoting natriuresis and endothelial protection as shown in preclinical studies. However, women have higher rates of CSA-AKI and these are exacerbated in postmenopausal women. This leads to the conundrum of whether sex, age, and hormonal status differences influence CSA-AKI. In this review, we briefly discuss the pathophysiology of CSA-AKI in CPB, and sex differences in kidney functions with a focus on the possible role of estrogen-specific effects in CPB and also possible differences in CPB in women including greater hemodilution. Further, we review strategies to prevent CSA-AKI in CPB with a highlight for potential sex-specific strategies. Improving our understanding of the impact of sex and sex hormones on CSA-AKI initiation and development will allow us to better manage the CPB strategies delivered to all patients.

Recurrent acute kidney injury is associated with delayed language development in infants with Congenital Heart Disease.

Neurodevelopmental delay is common in children who undergo surgery for Congenital Heart Disease (CHD) in infancy. Cardiac surgery associated acute kidney injury (CS-AKI) occurs frequently in the paediatric cardiac Intensive care unit (ICU). Cardiac surgery associated acute kidney injury (CS-AKI) is associated with worse neurodevelopmental scores and delay in cognitive, language, and motor domains in children with CHD. No known data exist regarding the association of CS-AKI and motor and language subscales. In this study, we explored the relationship between CS-AKI and receptive and expressive language, as well as gross and fine motor delay. This was a single centre retrospective observational cohort study. Children who underwent surgery for CHD and developed recurrent CS-AKI in the first year of life who had follow-up neurodevelopmental testing using the Bayley Scale of Infant Development Version III were included. Neurodevelopmental delay subscales assessed included: receptive and expressive language, fine and motor skills. The study cohort included 203 children. Recurrent CS-AKI was significantly associated with lower scores in receptive and expressive language, as well as fine and gross motor on unadjusted analyses. On adjusted analyses, recurrent CS-AKI was significantly associated with severe receptive language delay. The independent association of recurrent CS-AKI with severe language delay in children who undergo surgery for CHD in infancy is novel. Our findings may contribute to the understanding of language impairment in this population. Further studies are required to better understand this relationship and any potentially modifiable factors.

Features selection in a predictive model for cardiac surgery-associated acute kidney injury.

Cardiac surgery-associated acute kidney injury (CSA-AKI) is related to increased morbidity and mortality. However, limited studies have explored the influence of different feature selection (FS) methods on the predictive performance of CSA-AKI. Therefore, we aimed to compare the impact of different FS methods for CSA-AKI. CSA-AKI is defined according to the kidney disease: Improving Global Outcomes (KDIGO) criteria. Both traditional logistic regression and machine learning methods were used to select the potential risk factors for CSA-AKI. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of the models. In addition, the importance matrix plot by random forest was used to rank the features' importance. A total of 1977 patients undergoing cardiac surgery at Fuwai hospital from December 2018 to April 2021 were enrolled. The incidence of CSA-AKI during the first postoperative week was 27.8%. We concluded that different enrolled numbers of features impact the final selected feature number. The more you input, the more likely its output with all FS methods. In terms of performance, all selected features by various FS methods demonstrated excellent AUCs. Meanwhile, the embedded method demonstrated the highest accuracy compared with the LR method, while the filter method showed the lowest accuracy. Furthermore, NT-proBNP was found to be strongly associated with AKI. Our results confirmed some features that previous studies have reported and found some novel clinical parameters. In our study, FS was as suitable as LR for predicting CSA-AKI. For FS, the embedded method demonstrated better efficacy than the other methods. Furthermore, NT-proBNP was confirmed to be strongly associated with AKI.

Extracorporeal Blood Purification and Acute Kidney Injury in Cardiac Surgery

Cardiac surgery-associated acute kidney injury (CSA-AKI) remains a significant problem following cardiopulmonary bypass (CPB). Various strategies are proposed to attenuate CSA-AKI, including extracorporeal blood purification (EBP), but little is known about the effect of EBP through an acrylonitrile-sodium methallylsulfonate/polyethyleneimine membrane during CPB. To determine whether the use of an EBP device in a nonemergent cardiac surgery population reduces CSA-AKI after CPB. This double-blind, randomized clinical trial was conducted in 2 tertiary hospitals in Spain. Patients 18 years or older undergoing nonemergent cardiac surgery who were at high risk for CSA-AKI were enrolled from June 15, 2016, through November 5, 2021, with follow-up data through February 5, 2022. Of 1156 patients assessed, 343 patients were randomized (1:1) to either receive EBP or standard care. Nonselective EBP device connected to the CPB circuit. The primary outcome was the rate of CSA-AKI in the 7 days after randomization. Among 343 patients randomized (169 to receive EBP and 174 to receive usual care), the mean (SD) age was 69 (9) years and 119 were females. The rate of CSA-AKI was 28.4% (95% CI, 21.7%-35.8%) in the EBP group vs 39.7% (95% CI, 32.3%-47.3%) in the standard care group (P = .03), with an adjusted difference of 10.4% (95% CI, 2.3%-18.5%) using a log-binomial model (P = .01). No significant differences (P > .05) were observed in most of the predefined clinical secondary end points or post hoc exploratory end points. In a sensitivity analysis, EBP was found to be more effective in terms of CSA-AKI reduction in patients with chronic kidney disease, diabetes, hypertension, low left ventricular ejection fraction (<40%), and lower body mass index (<30). No differences were observed between the groups in adverse events tracking. The use of a nonselective EBP device connected to the CPB circuit in a nonemergent population of patients undergoing cardiac surgery was associated with a significant reduction of CSA-AKI in the first 7 days after surgery. ClinicalTrials.gov Identifier: NCT02518087.

Hemolysis Index, Carboxyhemoglobin, and Methemoglobin for the Early Identification of Patients at Risk for Cardiac Surgery–Associated Acute Kidney Injury

Hemolysis is a contributor to CS-AKI. Biochemistry analyzers provide a hemolysis index to quantify in vitro hemolysis, a condition that can, for example, affect the accuracy of potassium concentration measurements. We aimed to assess whether the postoperative plasma level of the hemolysis index (HIpostoperative) could aid the early recognition of patients at risk for cardiac surgery-associated acute kidney injury (CS-AKI) and also to evaluate other hemolysis indicators: plasma carboxyhemoglobin (COHbpostoperative) and methemoglobin (MetHbpostoperative). One-year retrospective study. University hospital. Patients undergoing elective cardiac surgery. None. In 1090 patients, the median HIpostoperative was higher in patients who developed CS-AKI compared to patients who did not (11 mg/dL [interquartile range (IQR), 5-38 mg/dL] v 7 mg/dL [IQR, 3-16 mg/dL]; p < 0.001). HIpostoperative refined the early recognition of CS-AKI: the area under the precision-recall curve (AUPRC) for HIpostoperative was 37% (95% confidence interval [CI], 31%-42%), whereas the AUPRC associated with no discriminative power, equal to the prevalence of CS-AKI in the whole population, was 21%. Among the 611 patients with measurements for all 3 biomarkers, the AUPRC of HIpostoperative was higher than that of COHbpostoperative or MetHbpostoperative (+6.6% and +7.4% respectively; p < 0.0001 for both). Unlike COHbpostoperative or MetHbpostoperative, the incorporation of HIpostoperative into a model (trained on a sample then validated in another sample) of CS-AKI early recognition significantly enhanced its performance, with a +1.9% (95% CI, 1.6%-2.1%) increase in AUPRC (p < 0.0001). Elevated HIpostoperative represents an early alert signal for the development of CS-AKI. Our findings support the incorporation of HIpostoperative, a readily available biomarker, into predictive scores of CS-AKI.

The Potential Role of Albumin in Reducing Cardiac Surgery-Associated Acute Kidney Injury: A Randomized Controlled Trial

The Potential Role of Albumin in Reducing Cardiac Surgery-Associated Acute Kidney Injury: A Randomized Controlled Trial

Deferoxamine for the Prevention of Cardiac Surgery-Associated AKI: The DEFEAT-AKI Randomized Clinical Trial

Deferoxamine for the Prevention of Cardiac Surgery-Associated AKI: The DEFEAT-AKI Randomized Clinical Trial

Incidence of Cardiac Surgery-Associated AKI in a Third-Level Hospital

Incidence of Cardiac Surgery-Associated AKI in a Third-Level Hospital

Derivation of a Simple Risk Model for Cardiac Surgery-Associated AKI

Derivation of a Simple Risk Model for Cardiac Surgery-Associated AKI

Biomarker-based acute kidney injury sub-phenotypes refine risk assessment in children undergoing cardiac surgery.

Pediatric cardiac surgery-associated acute kidney injury (CS-AKI) is common with variable association with outcomes, possibly because transient serum creatinine (SCr) elevations are unrelated to kidney disease. Sub-phenotypes of CS-AKI with biomarker integration may provide prognostic enrichment. This study aims to determine if combining early postoperative urine neutrophil gelatinase-associated lipocalin (uNGAL) and SCr into sub-phenotypes strengthens associations with AKI and outcomes. We hypothesized that patients with early subclinical (uNGAL + , SCr -) or damage (uNGAL + , SCr +) CS-AKI would have more postoperative day 2-4 KDIGO-defined AKI and worse clinical outcomes than patients with early functional AKI (uNGAL - , SCr +). Two-center prospective observational study evaluating combinations of early uNGAL (8-12h from ICU admission, ≥ 150ng/mL) and early postoperative (≤ 8h of admission) KDIGO SCr-defined AKI to predict CS-AKI on postoperative days (POD) 2-4. Four CS-AKI phenotypes were derived (uNGAL - /SCr - ; uNGAL + /SCr - ; uNGAL - /SCr + and uNGAL + /SCr +). The primary outcome was POD2-4 KDIGO SCr-defined CS-AKI. Secondary outcomes included ventilator and intensive care unit-free days (maximum 28). Four hundred seventy-six patients (median age 4.8 [IQR 1.4-30.4] months, 39% female) were included. POD2-4 AKI occurred in 44 (9.2%). 27% were uNGAL + /SCr - and 0.4% (n = 2) uNGAL + /SCr + . The adjusted odds of POD2-4 AKI was ninefold higher (aOR: 9.09, 95%CI: 3.84-21.53) in uNGAL + /SCr - when compared to uNGAL - /SCr - . uNGAL + /SCr - was associated with fewer ventilator-free (aOR: 0.30, 95%CI: 0.19-0.48) and ICU-free days (aOR: 0.41, 95%CI: 0.26-0.66) when compared to uNGAL - /SCr - . Early postoperative uNGAL, regardless of SCr elevation, refines risk assessment for pediatric POD2-4 CS-AKI and associated morbidity, enabling earlier AKI identification and prognostics.

Plasma-derived exosomal hsa-miR-184 and hsa-mir-6766-3p as promising diagnostic biomarkers for early detection of children’s cardiac surgery-associated acute kidney injury

There is little known about the contribution of exosomal microRNAs (exomiRs) in the children’s cardiac surgery-associated acute kidney injury (CSA-AKI). This study aimed to find diagnostic biomarkers for predicting CSA-AKI in children. A prospective observational study was conducted from April 2020 to March 2021.According to the changes of serum creatinine (SCr) value and urine volume within 48 h, the children were divided into acute kidney injury (AKI) group and non-AKI group. Serum samples were collected 4 h after cardiac surgery. Isolation of extracellular vesicles (EVs) and extraction of exomiRs from serum samples. Illumina high-throughput sequencing was used to quantify exomiRs and screen candidate microRNAs (miRNAs). Expression levels of candidate miRNAs were validated using droplet digital polymerase chain reaction (ddPCR). Normal and injuried rats’ kidney tissue were collected for tissue validation. In the pre-experimental stage (4 AKI vs. 4 non-AKI), hsa-miR-184, hsa-miR-4800-3p, hsa-miR-203a-3p and hsa-miR-6766-3p were selected as candidate genes. In the verification stage (8 AKI vs. 12 non-AKI), the expression of hsa-miR-184 in AKI group was significantly lower than that in non-AKI group (P = 0.031), and the expression of hsa-miR-4800-3p and hsa-miR-6766-3p in AKI group was significantly higher than that in non-AKI group (P = 0.01 and P = 0.047). There was no significant difference in the expression of hsa-miR-203a-3p between the two groups (P > 0.05). The expression of rats’ kidney tissue rno-miR-184 in AKI group was significantly lower than that in the normal group (P = 0.044). The area under the curve (AUC) of AKI predicted by hsa-miR-184 is 0.7865 and the AUC of hsa-miR-6766-3p is 0.7708. Combined with two kinds of miRNAs, the area under the curve of AKI is predicted to be 0.8646. The change of exomiRs level in circulatory system occurred in the early stage after cardiac operation, and the changes of hsa-miR-184 and hsa-miR-6766-3p content in circulatory system could predict CSA-AKI well.

Iron metabolism indexes as predictors of the incidence of cardiac surgery-associated acute kidney surgery

BackgroundAcute kidney injury (AKI) is a major complication following cardiac surgery. We explored the clinical utility of iron metabolism indexes for identification of patients at risk for AKI after cardiac surgery.MethodsThis prospective observational study included patients who underwent cardiac surgery between March 2023 and June 2023. Iron metabolism indexes were measured upon admission to the intensive care unit. Multivariable logistic regression analyses were performed to explore the relationship between iron metabolism indexes and cardiac surgery-associated AKI (CSA-AKI). Receiver operating characteristic (ROC) curve was used to assess the predictive ability of iron, APACHE II score and the combination of the two indicators. Restricted cubic splines (RCS) was used to further confirm the linear relationship between iron and CSA-AKI.ResultsAmong the 112 recruited patients, 38 (33.9%) were diagnosed with AKI. Multivariable logistic regression analysis indicated that APACHE II score (odds ratio [OR], 1.208; 95% confidence interval [CI], 1.003–1.455, P = 0.036) and iron (OR 1.069; 95% CI 1.009–1.133, P = 0.036) could be used as independent risk factors to predict CSA-AKI. ROC curve analysis showed that iron (area under curve [AUC] = 0.669, 95% CI 0.572–0.757), APACHE II score (AUC = 0.655, 95% CI 0.557–0.744) and iron and APACHE II score combination (AUC = 0.726, 95% CI 0.632–0.807) were predictive indicators for CSA-AKI. RCS further confirmed the linear relationship between iron and CSA-AKI.ConclusionsElevated iron levels were independently associated with higher risk of CSA-AKI, and there was a linear relationship between iron and CSA-AKI.

Characteristics of initiation timing and anticoagulation of continuous renal replacement therapy in patients following cardiac surgery: A retrospective analysis of 28 patients.

Continuous renal replacement therapy (CRRT) used in cardiac surgery-associated acute kidney injury (CSA-AKI) may have different characteristics from other diseases. We reviewed the medical records of patients with CSA-AKI requiring CRRT who underwent cardiac surgery from January 2020 to September 2021. Patients with AKI caused by other reasons who received CRRT during the same period were also evaluated. A total of 28 patients with CSA-AKI and 12 patients with AKI caused by other reasons were enrolled in this study. Compared with AKI patients caused by other reasons, patients with CSA-AKI were found to have lower mean arterial pressure, higher level of bilirubin, higher vasoactive-inotropic score, and larger daily diuretic dosage. The patients with CSA-AKI were prescribed CRRT earlier than the patients with AKI caused by other reasons. There was a significant difference in the CRRT anticoagulation method between patients with CSA-AKI and patients with AKI caused by other reasons. Six patients with CSA-AKI were treated with regional citrate anticoagulation (RCA), and the other 22 patients were treated with low molecular weight heparin or without anticoagulants. The timing of CRRT initiation in patients with CSA-AKI is earlier than that in patients with AKI caused by other reasons. Although RCA is recommended as the preferred anticoagulant for patients without contraindications, patients with CSA-AKI often have circulatory dysfunction and severe liver damage, so the risk of citrate accumulation is greater, whether to use RCA should be determined according to the individual condition of the patient.

Aminopeptidasic Enzymes as Early Biomarkers of Cardiac Surgery-Associated Acute Kidney Injury and Long-Term Events.

Diagnosis of acute kidney injury (AKI) relies on serum creatinine (SCr) changes. This study investigated if urinary aminopeptidases are early and predictive biomarkers of cardiac surgery-associated AKI (CSA-AKI). Glutamyl aminopeptidase (GluAp), alanyl aminopeptidase (AlaAp), dipeptidyl peptidase-4 (DPP4), proteinuria, albuminuria, N-acetyl-β-D-glucosaminidase (NAG), and neutrophile gelatinase-associated lipocalin (NGAL) were measured in urine samples from 44 patients at arrival in the intensive care unit (ICU) after cardiac surgery. Sensitivity, specificity, and positive and negative predictive value for diagnosis of stages 1, 2, and 3 of AKI were analyzed for the highest quartile of each marker. We also studied the relationship with SCr after surgery, 6- and 12-month glomerular filtration rates (GFRs), and other long-term events over the next 5 years. GluAp diagnosed the maximal number of patients that developed stage 2 or 3 of AKI, increasing diagnostic sensitivity from 0% to 75%. In addition, GluAp and DPP4 were related to the decrease in GFR at 6 or 12 months after surgery. Urinary aminopeptidases are a potential tool for the early diagnosis of CSA-AKI, with GluAp being the most effective marker for diagnosing stage 2 or 3 of AKI at ICU admission. GluAp and DPP4 serve as predictive biomarkers for a decrease in GFR.

Machine Learning with Clinical and Intraoperative Biosignal Data for Predicting Cardiac Surgery-Associated Acute Kidney Injury.

Early identification of patients at high risk of cardiac surgery-associated acute kidney injury (CSA-AKI) is crucial for its prevention. We aimed to leverage perioperative clinical and intraoperative biosignal data to develop machine learning models that predict CSA-AKI. We introduced a novel approach for extracting relevant features from high-resolution intraoperative biosignals to reflect the patient's baseline status, the extent of unfavorable conditions encountered intraoperatively, and data variability. We developed XGBoost models from 2,003 patients across three consecutive perioperative phases using: 1) only preoperative, 2) pre- and intraoperative, and 3) pre-, intra-, and postoperative variables. The predictive performance progressively improved throughout the three consecutive perioperative phases (e.g., AUROC of 0.767 to 0.797 and 0.840), all surpassing the Thakar Score's performance. According to the SHAP method, intraoperative perfusion pressure was most important in the prediction, highlighting the importance of intraoperative patient management and the use of high-resolution biosignal data in predictive modeling to analyze hemodynamic fluctuations during surgery. Early postoperative biomarkers were also important predictors, highlighting the importance of intensified monitoring early after surgery.

Cardiac surgery associated acute kidney injury, incidence, and predictors. Prospective observational single center study.

Acute kidney injury (AKI) is a condition characterized by a sudden decline in kidney function, leading to accumulation of waste products and fluids in the body. It is a common and serious complication in patients with cardiovascular diseases, and it is associated with increased morbidity and mortality.&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Aim&lt;/b&gt;&lt;br /&gt; In this study, we explore the relationship between cardiac issues and the development of AKI, as well as strategies for its prevention and management. The primary aim of this study is to examine the incidence and risk factors for the AKI in patients admitted to the cardiac intensive care unit/CICU), as well as the impact of AKI on patient outcomes.&lt;br /&gt; &lt;b&gt;&amp;nbsp;&lt;/b&gt;&lt;br /&gt; &lt;b&gt;Methods&lt;/b&gt;&lt;br /&gt; We conducted prospective observational single center study. 292 consecutive patients admitted to ICU after open heart surgery by sternotomy were included. Patients were monitored in ICU for frequency of AKI, perioperative risk factors, cardiac surgery-associated acute kidney injury (CSA-AKI) and their impact on patients’ outcome.&lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;&lt;br /&gt; After admission to the intensive care unit, 33 patients (11.3%) developed CSA-AKI in the postoperative period. According to the analysis, male gender (p=0.03), decreased GFR (p=0.02) as well as high EuroSCORE II (p=0.013), hemoglobin level before surgery (p = 0.002) and the presence of diabetes and chronic kidney disease (p=0.03) were independent predictors of AKI after open-heart surgery. In patients who developed AKI, the duration of artificial lung ventilation was increased (21.3 vs 9.9 hours p = 0.001) and the duration of stay in the intensive care unit (4.3 vs. 1.9 days, P = 0.02).&lt;br /&gt; &lt;b&gt;&amp;nbsp;Conclusion:&lt;/b&gt;&lt;br /&gt; Patients often have AKI after heart surgery. EuroSCORE II, gender, diabetes, time of cardiopulmonary bypass and chronic kidney disease are independent predictors of AKI development. The appearance of AKI is due to an unfavorable outcome of events. The appearance of acute kidney injury is associated with adverse consequences.&lt;br /&gt; &lt;b&gt;&amp;nbsp;Key words: &lt;/b&gt;Acute kidney injury, cardiac surgery, predictors of AKI, postoperative period.&lt;br /&gt; &lt;br /&gt; &amp;nbsp;&lt;b&gt;Conflict of interests: &lt;/b&gt;The authors declare no conflict of interest.

Machine learning-based prediction of off-pump coronary artery bypass grafting-associated acute kidney injury.

The cardiac surgery-associated acute kidney injury (CSA-AKI) occurs in up to 1 out of 3 patients. Off-pump coronary artery bypass grafting (OPCABG) is one of the major cardiac surgeries leading to CSA-AKI. Early identification and timely intervention are of clinical significance for CSA-AKI. In this study, we aimed to establish a prediction model of off-pump coronary artery bypass grafting-associated acute kidney injury (OPCABG-AKI) after surgery based on machine learning methods. The preoperative and intraoperative data of 1,041 patients who underwent OPCABG in Chest Hospital, Tianjin University from June 1, 2021 to April 30, 2023 were retrospectively collected. The definition of OPCABG-AKI was based on the 2012 Kidney Disease Improving Global Outcomes (KDIGO) criteria. The baseline data and intraoperative time series data were included in the dataset, which were preprocessed separately. A total of eight machine learning models were constructed based on the baseline data: logistic regression (LR), gradient-boosting decision tree (GBDT), eXtreme gradient boosting (XGBoost), adaptive boosting (AdaBoost), random forest (RF), support vector machine (SVM), k-nearest neighbor (KNN), and decision tree (DT). The intraoperative time series data were extracted using a long short-term memory (LSTM) deep learning model. The baseline data and intraoperative features were then integrated through transfer learning and fused into each of the eight machine learning models for training. Based on the calculation of accuracy and area under the curve (AUC) of the prediction model, the best model was selected to establish the final OPCABG-AKI risk prediction model. The importance of features was calculated and ranked by DT model, to identify the main risk factors. Among 701 patients included in the study, 73 patients (10.4%) developed OPCABG-AKI. The GBDT model was shown to have the best predictions, both based on baseline data only (AUC =0.739, accuracy: 0.943) as well as based on baseline and intraoperative datasets (AUC =0.861, accuracy: 0.936). The ranking of importance of features of the GBDT model showed that use of insulin aspart was the most important predictor of OPCABG-AKI, followed by use of acarbose, spironolactone, alfentanil, dezocine, levosimendan, clindamycin, history of myocardial infarction, and gender. A GBDT-based model showed excellent performance for the prediction of OPCABG-AKI. The fusion of preoperative and intraoperative data can improve the accuracy of predicting OPCABG-AKI.

The Importance of Monitoring Blood Glucose Test in Patients Post-operative Coronary Artery Bypass Graft Surgery

Hyperglycemia is a risk factor for cardiac surgery-associated acute kidney injury in post-operative coronary artery bypass graft surgery patients. Glycemic control is important to prevent cardiac surgery-associated acute kidney injury. Postoperative glycemic control suggested 110-150 mg/dL. The aims of this study were to lower blood glucose levels and reduce the risk of occurrence or severity of cardiac surgery-associated acute kidney injury in post coronary artery bypass graft surgery patients. This study was conducted with a case study design involving 2 post operative coronary artery bypass graft patients who experienced hyperglycemia on the 1st to the 3rd day of treatment. Data collection was carried out from May 22 to May 23, 2023. The results of the case study showed that monitoring blood glucose in post-cardiac surgery patients is very important. Both patients experienced hyperglycemia in the early postoperative phase. With close monitoring and administration of insulin therapy according to the doctor's advice, the blood sugar levels of both patients were controlled. Monitoring urine output and evaluating serum creatinine levels showed that the first patient had cardiac surgery-associated acute kidney injury stage 1 on day 2 and showed improvement on day 3. The second patient did not develop cardiac surgery-associated acute kidney injury. The role of critical nurses in monitoring blood glucose levels and administering insulin doses is supported by related research. Strict monitoring and target ranges of blood glucose levels, in collaboration with the medical team are necessary to reduce the risk of cardiac surgery-associated acute kidney injury events.

EValuating the Effect of periopeRaTIve empaGliflOzin on cardiac surgery associated acute kidney injury: rationale and design of the VERTIGO study.

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a serious complication in patients undergoing cardiac surgery with extracorporeal circulation (ECC) that increases postoperative complications and mortality. CSA-AKI develops due to a combination of patient- and surgery-related risk factors that enhance renal ischemia-reperfusion injury. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) such as empagliflozin reduce renal glucose reabsorption, improving tubulo-glomerular feedback, reducing inflammation and decreasing intraglomerular pressure. Preclinical studies have observed that SGLT2i may provide significant protection against renal ischemia-reperfusion injury due to their effects on inadequate mitochondrial function, reactive oxygen species activity or renal peritubular capillary congestion, all hallmarks of CSA-AKI. The VERTIGO (EValuating the Effect of periopeRaTIve empaGliflOzin) trial is a Phase 3, investigator-initiated, randomized, double-blind, placebo-controlled, multicenter study that aims to explore whether empagliflozin can reduce the incidence of adverse renal outcomes in cardiac surgery patients. The VERTIGO study (EudraCT: 2021-004938-11) will enroll 608 patients that require elective cardiac surgery with ECC. Patients will be randomly assigned in a 1:1 ratio to receive either empagliflozin 10mg orally daily or placebo. Study treatment will start 5days before surgery and will continue during the first 7days postoperatively. All participants will receive standard care according to local practice guidelines. The primary endpoint of the study will be the proportion of patients that develop major adverse kidney events during the first 90days after surgery, defined as ≥25% renal function decline, renal replacement therapy initiation or death. Secondary, tertiary and safety endpoints will include rates of AKI during index hospitalization, postoperative complications and observed adverse events. The VERTIGO trial will describe the efficacy and safety of empagliflozin in preventing CSA-AKI. Patient recruitment is expected to start in May 2024.