Biomarkeri akutnog oštećenja bubrega nakon kardiohirurških operacija odraslih pacijenata

Abstract

Kardiohirurške operacije izvedene uz kardiopulmonalni by-pass (CPB) su drugi najčešći uzrok AOB, što je povezano sa porastom mortaliteta, morbiditeta i dužinom hospitalizacije. AOB udruženo sa kardiohirurškim procedurama (CSA-AKI) karakteriše naglo pogoršanje funkcije bubrega, koje nastaje pod uticajem raznih faktora kao što su: ishemijsko-reperfuziona oštećenja, metaboličke abnormalnosti, aktivacija neurohumoralnog odgovora, zapaljenski i oksidativni stres kao i egzogeni i endogeni toksini. Incidenca pojave CSA-AKI je između 8,9% i 39%. Cilj: Utvrđivanje incidence, značaja opštih karakteristika, specifičnih parametara vezanih za CPB, standardnih laboratorijskih, gasnih i analiza acidobaznog statusa, standardnih pokazatelja bubrežne funkcije i novih biomarkera bubrežnog oštećenja (KIM-1 i u-NGAL) u nastanku, ranom otkrivanju i predikciji akutnog oštećenja bubrega kod elektivnih kardiohirurških operacija. Bolesnici i metode: Ova prospektivna, opservaciona studija uključuje 100 odraslih niskorizičnih bolesnika za razvoj AOB, planiraih za izvođenje elektivnih kardiohirurških intervencija uz primenu CPB-a: aortokoronarnog by-passa, valvularne hirurgije i kombinovanih procedura (koronarna i valvularna hirurgija). Svim bolesnicima su preoperativno prikupljeni anamnestički podaci, obavljen je fizikalni pregled, izmereni hemodinamski parametri i zabeležena ejekciona frakcija (EF). Izvršena je klasifikacija bolesnika po NYHA protokolu i procenjen je operativni rizik za razvoj AOB primenom dva skora: Cleveland Clinic score (CCS) i Leicester Cardiac Surgery Research AKI Risk Score kalkulatora (LCSRARS)...

Cardiac surgery procedures with cardiopulmonary by-pass (CPB) are the second most common cause of Acute Kidney Injury (AKI), which is connected with the increase of mortality, morbidity and the length of hospitalization. AKI associated with cardiovascular procedures (CSA-AKI) is characterized by rapid deterioration of kidney function, which is caused by various factors such as: ischemicreperfusion injury, metabolic abnormalities, activation of neurohumoral response, inflammatory and oxidative stress, as well as exogenous and endogenous toxins. The incidence of CSA-AKI is between 8.9% and 39%. Goal: Determination of incidence and the significance of general characteristics, specific parameters related to cardiopulmonary by-pass, standard laboratory, gas and acid-base status analysis, standard renal function indicators and novel biomarkers of kidney injury (KIM-1 and u-NGAL) in emergence, early detection and the prediction of acute kidney injury in elective cardiac surgery procedures. Patients and Methods: This prospective, observational study included 100 adult, low-risk patients for Acute Kidney Injury (AKI) development, planned for elective cardiac surgery with cardio pulmonary bypass (CPB): aortocoronary bypass surgery, heart valve surgery and combined procedures (coronary and heart valve surgery). All patients were preoperatively examined, anamnestic data were collected, physical examination performed, hemodynamic parameters measured and ejection fraction recorded. The classification of patients under the NYHA protocol was performed and the operational risk for the development of AKI was evaluated using two scores: Cleveland Clinic score (CCS) and Leicester Cardiac Surgery Research AKI Risk Score (LCSRARS). The blood and urine samples were taken the day before operation, shortly before or immediately after CPB, as well as 3h, 12h, 24h and 48h after the CPB was performed...