Risk Factors of Acute Kidney Injury after Pediatric Cardiac Surgery: A Meta-analysis
Jef Van den Eynde1, Boris Delpire1, Xander Jacquemin1, Ismat Pardi1, Michel Pompeu B. O. Sá2, Wouter Oosterlinck1
1University Hospitals of Leuven, Leuven, Belgium, 2Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco – PROCAPE. University of Pernambuco – UPE., Recife, Brazil
BACKGROUND: Cardiac surgery-associated acute kidney injury (CS-AKI) is associated with increased morbidity and mortality in both adults and children. This study aimed to identify risk factors for AKI following cardiac surgery in the pediatric population.
METHODS: PubMed/MEDLINE, Embase, Scopus, and reference lists of relevant articles were searched for observational studies published by August 2020. Random-effects meta-analysis was performed, comparing demographic data in patients who developed CS-AKI and those who did not.
RESULTS: Fifty-four publications including a total of 17,134 patients (CS-AKI: 5,811 patients; no CS-AKI: 11,323 patients) were included from studies published from 2007 to 2020. Preoperative risk factors were pulmonary hypertension (OR=1.84, 95%CI 1.04;3.27), cyanotic heart disease (OR=2.73, 95%CI 2.00;3.73), univentricular heart (OR=1.67, 95%CI 1.22;2.29), nephrotoxic drugs (OR=1.31, 95%CI 1.00;1.70), vasopressor use (OR=2.61, 95%CI 1.57;4.35), age (-4.31 months, 95%CI -6.60;-2.03), weight (-1.74kg, 95%CI -2.81;-0.67), preoperative creatine (-0.08mg/dl, 95%CI -0.16;-0.01), and preoperative eGFR (8.06 ml/min/1.73m˛, 95%CI 3.81;12.31). Intraoperative risk factors were cardiopulmonary bypass (OR=1.86, 95%CI 1.09;3.16), transfusion (OR=1.51, 95%CI 1.14-1.98), reoperation (OR=5.36, 95%CI 3.00-9.59), cardiopulmonary bypass time (29.04 minutes, 95%CI 21.83-36.25), aortic cross-clamp time (11.04 minutes, 95%CI 5.52-16.56), and volume of transfusion (13.90 ml/kg, 95%CI 7.79-20.01). Postoperative risk factors were sepsis (OR=4.28, 95%CI 3.18-5.75), intensive care unit length of stay (3.58 days, 95%CI 2.61;4.55), and hospital length of stay (4.68 days, 95%CI 2.91;6.46). Sex, anemia, preoperative blood urea nitrogen, operative time, and ventilation time were no significant risk factors.
CONCLUSIONS: This meta-analysis identified preoperative, intraoperative, and postoperative risk factors that are associated with CS-AKI in the pediatric population.