Evaluation of Acute Kidney Injury in Postcardiotomy Cardiogenic Shock Patients Supported by Extracorporeal Membrane Oxygenation

¹ Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Medicine, Chinese Academy of Medical Science & Peking Union Medical College, 100037 Beijing, China

² Department of Pain Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, 102218 Beijing, China

^*Correspondence: jibingyang@fuwai.com (Bingyang Ji)
^†These authors contributed equally.

Rev. Cardiovasc. Med. 2023, 24(3), 91; https://doi.org/10.31083/j.rcm2403091

Submitted: 23 October 2022 | Revised: 1 December 2022 | Accepted: 6 December 2022 | Published: 16 March 2023

This is an open access article under the CC BY 4.0 license.

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Abstract

Background: This study sought to evaluate the incidence of acute kidney injury (AKI) defined by the Kidney Disease: Improving Global Outcomes (KDIGO) group in patients supported by veno-arterial extracorporeal membrane oxygenation (VA ECMO) after post-cardiotomy cardiogenic shock (PCS), and to identify the risk factors for AKI $\geq$ 3. Methods: Patients with and without AKI $\geq$ 3 were divided into two groups. Potential risk factors for developing AKI $\geq$ 3 were evaluated by univariate logistic regression analysis. Patient risk factors (p $<$ 0.1) in the univariate analysis were entered into the multivariable logistic regression model. The tolerance and variance inflation factors (VIF) were calculated to evaluate the collinearity of the potential variables. Results: 136 patients with a mean age of 53.6 $\pm{}$ 13.9 years (66.9% male) were enrolled in the study. 80 patients (58.8%) developed AKI $\geq$ 3. Patients with AKI $\geq$ 3 required significantly longer mechanical ventilation (200.9 [128.0, 534.8] hours vs. 78.9 [13.0, 233.0] hours, p $<$ 0.001). The ICU stay and hospital stay of patients with AKI $\geq$ 3 were much longer than patients with AKI $<$ 3 (384 [182, 648] hours vs. 216 [48, 456] hours, p = 0.001; 25.0 [15.3, 46.6] days vs. 13.4 [7.4, 38.4] days, p = 0.022, respectively). There was no difference in preoperative risk factors between the two groups. Age, cross-clamp time, cardiopulmonary bypass (CPB) time, the timing of ECMO implantation, mean artery pressure (MAP), lactate concentration before ECMO, and preoperative ejection fraction (EF) were entered into the multivariable analysis. The timing of ECMO implantation was an independent risk factor for AKI $\geq$ 3 (p = 0.036). Intraoperatively implantation of ECMO may decrease the incidence of AKI $\geq$ 3 (odds ratio (OR) = 0.298, 95% confidence interval (CI) = 0.096–0.925). The tolerance and variance inflation factors showed that there was no collinearity among these variables. Conclusions: The incidence of AKI $\geq$ 3 in patients supported by VA ECMO after PCS was 58.8% in our center. Patients with AKI $\geq$ 3 required significantly longer mechanical ventilation and hospital stay. Intraoperative implantation VA ECMO was associated with a decreased incidence of AKI $\geq$ 3.

Keywords

extracorporeal membrane oxygenation

postcardiotomy cardiogenic shock

acute kidney injury

incidence

risk factor

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Rev. Cardiovasc. Med. Print ISSN 1530-6550 Electronic ISSN 2153-8174