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Intraoperative Oliguria with Decreased SvO(2) Predicts Acute Kidney Injury after Living Donor Liver Transplantation
Acute kidney injury (AKI) is a frequent complication after living donor liver transplantation (LDLT), and is associated with increased mortality. However, the association between intraoperative oliguria and the risk of AKI remains uncertain for LDLT. We sought to determine the association between in...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351957/ https://www.ncbi.nlm.nih.gov/pubmed/30597881 http://dx.doi.org/10.3390/jcm8010029 |
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author | Kim, Won Ho Lee, Hyung-Chul Lim, Leerang Ryu, Ho-Geol Jung, Chul-Woo |
author_facet | Kim, Won Ho Lee, Hyung-Chul Lim, Leerang Ryu, Ho-Geol Jung, Chul-Woo |
author_sort | Kim, Won Ho |
collection | PubMed |
description | Acute kidney injury (AKI) is a frequent complication after living donor liver transplantation (LDLT), and is associated with increased mortality. However, the association between intraoperative oliguria and the risk of AKI remains uncertain for LDLT. We sought to determine the association between intraoperative oliguria alone and oliguria coupled with hemodynamic derangement and the risk of AKI after LDLT. We evaluated the hemodynamic variables, including mean arterial pressure, cardiac index, and mixed venous oxygen saturation (SvO(2)). We reviewed 583 adult patients without baseline renal dysfunction and who did not receive hydroxyethyl starch during surgery. AKI was defined using the Kidney Disease Improving Global Outcomes criteria according to the serum creatinine criteria. Multivariable logistic regression analysis was performed with and without oliguria and oliguria coupled with a decrease in SvO(2). The performance was compared with respect to the area under the receiver operating characteristic curve (AUC). Intraoperative oliguria <0.5 and <0.3 mL/kg/h were significantly associated with the risk of AKI; however, their performance in predicting AKI was poor. The AUC of single predictors increased significantly when oliguria was combined with decreased SvO(2) (AUC 0.72; 95% confidence interval (CI) 0.68–0.75 vs. AUC of oliguria alone 0.61; 95% CI 0.56–0.61; p < 0.0001; vs. AUC of SvO(2) alone 0.66; 95% CI 0.61–0.70; p < 0.0001). Addition of oliguria coupled with SvO(2) reduction also increased the AUC of multivariable prediction (AUC 0.87; 95% CI 0.84–0.90 vs. AUC with oliguria 0.73; 95% CI 0.69–0.77; p < 0.0001; vs. AUC with neither oliguria nor SvO(2) reduction 0.68; 95% CI 0.64–0.72; p < 0.0001). Intraoperative oliguria coupled with a decrease in SvO(2) may suggest the risk of AKI after LDLT more reliably than oliguria alone or decrease in SvO(2) alone. Intraoperative oliguria should be interpreted in conjunction with SvO(2) to predict AKI in patients with normal preoperative renal function and who did not receive hydroxyethyl starch during surgery. |
format | Online Article Text |
id | pubmed-6351957 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-63519572019-02-01 Intraoperative Oliguria with Decreased SvO(2) Predicts Acute Kidney Injury after Living Donor Liver Transplantation Kim, Won Ho Lee, Hyung-Chul Lim, Leerang Ryu, Ho-Geol Jung, Chul-Woo J Clin Med Article Acute kidney injury (AKI) is a frequent complication after living donor liver transplantation (LDLT), and is associated with increased mortality. However, the association between intraoperative oliguria and the risk of AKI remains uncertain for LDLT. We sought to determine the association between intraoperative oliguria alone and oliguria coupled with hemodynamic derangement and the risk of AKI after LDLT. We evaluated the hemodynamic variables, including mean arterial pressure, cardiac index, and mixed venous oxygen saturation (SvO(2)). We reviewed 583 adult patients without baseline renal dysfunction and who did not receive hydroxyethyl starch during surgery. AKI was defined using the Kidney Disease Improving Global Outcomes criteria according to the serum creatinine criteria. Multivariable logistic regression analysis was performed with and without oliguria and oliguria coupled with a decrease in SvO(2). The performance was compared with respect to the area under the receiver operating characteristic curve (AUC). Intraoperative oliguria <0.5 and <0.3 mL/kg/h were significantly associated with the risk of AKI; however, their performance in predicting AKI was poor. The AUC of single predictors increased significantly when oliguria was combined with decreased SvO(2) (AUC 0.72; 95% confidence interval (CI) 0.68–0.75 vs. AUC of oliguria alone 0.61; 95% CI 0.56–0.61; p < 0.0001; vs. AUC of SvO(2) alone 0.66; 95% CI 0.61–0.70; p < 0.0001). Addition of oliguria coupled with SvO(2) reduction also increased the AUC of multivariable prediction (AUC 0.87; 95% CI 0.84–0.90 vs. AUC with oliguria 0.73; 95% CI 0.69–0.77; p < 0.0001; vs. AUC with neither oliguria nor SvO(2) reduction 0.68; 95% CI 0.64–0.72; p < 0.0001). Intraoperative oliguria coupled with a decrease in SvO(2) may suggest the risk of AKI after LDLT more reliably than oliguria alone or decrease in SvO(2) alone. Intraoperative oliguria should be interpreted in conjunction with SvO(2) to predict AKI in patients with normal preoperative renal function and who did not receive hydroxyethyl starch during surgery. MDPI 2018-12-28 /pmc/articles/PMC6351957/ /pubmed/30597881 http://dx.doi.org/10.3390/jcm8010029 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Kim, Won Ho Lee, Hyung-Chul Lim, Leerang Ryu, Ho-Geol Jung, Chul-Woo Intraoperative Oliguria with Decreased SvO(2) Predicts Acute Kidney Injury after Living Donor Liver Transplantation |
title | Intraoperative Oliguria with Decreased SvO(2) Predicts Acute Kidney Injury after Living Donor Liver Transplantation |
title_full | Intraoperative Oliguria with Decreased SvO(2) Predicts Acute Kidney Injury after Living Donor Liver Transplantation |
title_fullStr | Intraoperative Oliguria with Decreased SvO(2) Predicts Acute Kidney Injury after Living Donor Liver Transplantation |
title_full_unstemmed | Intraoperative Oliguria with Decreased SvO(2) Predicts Acute Kidney Injury after Living Donor Liver Transplantation |
title_short | Intraoperative Oliguria with Decreased SvO(2) Predicts Acute Kidney Injury after Living Donor Liver Transplantation |
title_sort | intraoperative oliguria with decreased svo(2) predicts acute kidney injury after living donor liver transplantation |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351957/ https://www.ncbi.nlm.nih.gov/pubmed/30597881 http://dx.doi.org/10.3390/jcm8010029 |
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