Ian Justement
Baylor College of Medicine Texas Children's Hospital
Houston, Texas
Disclosure information not submitted.
Andrea Marroquin, LEN
Research Scholar
Texas Children's Hospital and Baylor College of Medicine, Texas, United States
Disclosure information not submitted.
Ayse Akcan-Arikan, MD
Assoc Prof of Pediatrics, Medical Dir of Critical Care Nephrology
Baylor College of Medicine at Texas Childrens Hospital
Houston, Texas
Disclosure information not submitted.
Jaime Silva-Gburek, MD
Instructor
Texas Children's Hospital and Baylor College of Medicine, Texas, United States
Disclosure information not submitted.
Thomas Fogarty, III, MD
Assistant Professor
Texas Children's Hospital and Baylor College of Medicine
Houston, Texas, United States
Disclosure information not submitted.
Andrea Ontaneda, MD
Assistant Professor
Texas Children's Hospital and Baylor College of Medicine, United States
Disclosure information not submitted.
Jeramy Roddy, MD
Assistant Professor
Texas Children's Hospital and Baylor College of Medicine, United States
Disclosure information not submitted.
Natasha Afonso, MD, MPH
Assistant Professor
Texas Children's Hospital and Baylor College of Medicine, United States
Disclosure information not submitted.
Lara Shekerdemian, FRACP, FCICM
Chief Pediatric Intensive Care
Baylor College of Medicine Texas Children's Hospital
Houston, Texas
Disclosure information not submitted.
Jorge Coss-Bu, MD
Professor of Pediatrics, Division of Pediatric Critical Care Medicine
Baylor College of Medicine/ Texas Children's Hospital, Texas, United States
Disclosure information not submitted.
Title: Nutritional Status and Cardiac Surgery Associated Acute Kidney Injury and Impact on Patient Outcomes
Introduction/Hypothesis: Malnutrition (MAL) and acute kidney injury (AKI) are common in children after undergoing surgery for congenital heart disease (CHD) and both have been independently associated with increased morbidity and mortality. The study aim was to assess the development of cardiac surgery associated AKI (CSA-AKI) in children admitted to the cardiac ICU (CICU) after surgery for CHD, and its impact on renal recovery and patient outcomes.
Methods: Retrospective study of children admitted for ≥48 hrs after surgery for CHD between 01/12 and 12/14. Complexity was according to Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category, CSA-AKI was defined according to KDIGO creatinine criteria, persistent CSA-AKI was as CSA-AKI lasting ≥ 48 hours, renal recovery was resolution of CSA-AKI by post-operative day 5, and MAL defined according to WHO and CDC weight-for-age (WFA) z-score < -1. Multivariate analyses by logistic regression.
Results: A total of 735 children were enrolled (44% females), median (IQR) age 1.16 (0.38-4.87) yrs, weight 9 (5.6-17.9) kg, duration of mechanical ventilation (MV) 23.5 (8.2-37) hrs, CICU LOS 3 (2-6) days, hospital LOS 8 (5-12) days. The prevalence of MAL was 47.3%. CSA-AKI was 17.4% with a predominance of Stage 1 AKI (61%), persistent CSA-AKI was 2.5%; 97.5% of patients had renal recovery. Hospital mortality was 1.5%. When adjusting for STAT category there was a significant association between CSA-AKI and both cardiopulmonary bypass (CPB) time and age < 1 yr: Odds ratio (OR) (95% CI) 2.2, (1.37-3.52), p=0.001 and OR, 1.01 (1.00-1.01), p< 0.0001; respectively; there was not association with MAL and MV; OR, 0.94 (0.6-1.48), p=0.784, and OR, 1.00 (1.00 -1.00), p= 0.2605, respectively. When adjusting for STAT category, age, malnutrition, CSA-AKI and duration of MV, there was a significant association between mortality and both STAT category and CPB time: OR 7.54, (1.25-45), p=0.0275 and OR, 1.01 (1.00-1.02), p=0.0217, respectively.
Conclusions: Malnutrition was common on admission for congenital heart disease surgery and almost 1 in 5 pts had acute kidney injury after cardiac surgery. By post-operative day 5 most patients exhibited renal recovery. Regardless of the presence of malnutrition or acute kidney injury overall mortality remained low.