Can Inflammation Indices Preoperatively Predict Acute Kidney Injury after Cardiac Surgery?
DOI:
https://doi.org/10.59958/hsf.6767Keywords:
cardiac surgery, inflammation, acute kidney injuryAbstract
Background: Coronary artery disease is a condition characterized by atherosclerosis and inflammation in the vessel wall. In patient undergoing surgery, a systemic inflammatory-like condition occurs in the postoperative period through mediators that develop due to acute stress. Methods: 581 patients enrolled from the hospital records from 2019 and 2022 retrospectively. Systemic immune inflammation index (SII), systemic inflammation response index (SIRI) and aggregated index of systemic inflammation (AISI) values were calculated from peripheral blood samples taken at hospital admission using the formula SII = platelet (P) × neutrophil (N) / lymphocyte (L), SIRI = N × monocyte (M) / L, AISI = (N × M × P) / L. Results: The mean age of the 581 patients included in the study was 63.97 ± 8.77 years. 45% of the patients were women. Mean cardio-pulmonary bypass time (CPBT) was 100.31 ± 31.94 and mean cross-clamp time (CCT) was 59.79 ± 24.07. When the correlation of acute kidney injury (AKI) development was analyzed with the variables (P/L ratio, N/L ratio, SII, SIRI, AISI, CCT and CPBT), all variables we tested and age were found to be significantly correlated (p < 0.01). Conclusion: We think that the calculations we tested in our study, together with the understanding of the complexity of the inflammatory system, will constitute an important step in the detection of AKI.
References
Antoniades C, Demosthenous M, Reilly S, Margaritis M, Zhang MH, Antonopoulos A, et al. Myocardial redox state predicts in-hospital clinical outcome after cardiac surgery effects of short-term pre-operative statin treatment. Journal of the American College of Car-diology. 2012; 59: 60–70.
Magoon R, Makhija N. Endothelial Glycocalyx and Cardiac Surgery: Newer Insights. Journal of Cardiothoracic and Vascular Anesthesia. 2020; 34: 310–311.
Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. The New England Journal of Medicine. 2005; 352: 1685–1695.
Bridgewater B, Grayson AD, Jackson M, Brooks N, Grotte GJ, Keenan DJM, et al. Surgeon specific mortality in adult cardiac surgery: comparison between crude and risk stratified data. BMJ (Clinical Research Ed.). 2003; 327: 13–17.
Bagger JP, Zindrou D, Taylor KM. Leukocyte count: a risk factor for coronary artery bypass graft mortality. The American Journal of Medicine. 2003; 115: 660–663.
Gurm HS, Bhatt DL, Lincoff AM, Tcheng JE, Kereiakes DJ, Kleiman NS, et al. Impact of preprocedural white blood cell count on long term mortality after percutaneous coronary intervention: insights from the EPIC, EPILOG, and EPISTENT trials. Heart (British Cardiac Society). 2003; 89: 1200–1204.
Conlon PJ, Stafford-Smith M, White WD, Newman MF, King S, Winn MP, et al. Acute renal failure following cardiac surgery. Nephrology, Dialysis, Transplantation: Official Publication of the European Dialysis and Transplant Association - European Re-nal Association. 1999; 14: 1158–1162.
Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, Bauer P, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. Journal of the American Society of Nephrology: JASN. 2004; 15: 1597–1605.
Thakar CV, Yared JP, Worley S, Cotman K, Paganini EP. Renal dysfunction and serious infections after open-heart surgery. Kid-ney International. 2003; 64: 239–246.
Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005; 294: 813–818.
Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J. Independent association between acute renal failure and mortali-ty following cardiac surgery. The American Journal of Medicine. 1998; 104: 343–348.
Fuhrman DY, Kellum JA. Epidemiology and pathophysiology of cardiac surgery-associated acute kidney injury. Current Opinion in Anaesthesiology. 2017; 30: 60–65.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Critical Care (London, England). 2007; 11: R31.
Kellum JA, Lameire N. KDIGO Clinical Practice Guideline for acute kidney injury 2012. Kidney International Supplements. 2012; 2: 1–138.
Traynor J, Mactier R, Geddes CC, Fox JG. How to measure renal function in clinical practice. BMJ (Clinical Research Ed.). 2006; 333: 733–737.
Bock JS, Gottlieb SS. Cardiorenal syndrome: new perspectives. Circulation. 2010; 121: 2592–2600.
Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment. Nature Reviews. Nephrology. 2017; 13: 697–711.
Vermeulen Windsant IC, de Wit NCJ, Sertorio JTC, van Bijnen AA, Ganushchak YM, Heijmans JH, et al. Hemolysis during cardiac surgery is associated with increased intravascular nitric oxide consumption and perioperative kidney and intestinal tissue damage. Frontiers in Physiology. 2014; 5: 340.
Zhang WR, Garg AX, Coca SG, Devereaux PJ, Eikelboom J, Kavsak P, et al. Plasma IL-6 and IL-10 Concentrations Predict AKI and Long-Term Mortality in Adults after Cardiac Surgery. Journal of the American Society of Nephrology: JASN. 2015; 26: 3123–3132.
Thiele RH, Isbell JM, Rosner MH. AKI associated with cardiac surgery. Clinical Journal of the American Society of Nephrology: CJASN. 2015; 10: 500–514.
Coleman MD, Shaefi S, Sladen RN. Preventing acute kidney injury after cardiac surgery. Current Opinion in Anaesthesiology. 2011; 24: 70–76.
Coppolino G, Presta P, Saturno L, Fuiano G. Acute kidney injury in patients undergoing cardiac surgery. Journal of Nephrology. 2013; 26: 32–40.
