Acute kidney injury in patients with multiple organ dysfunction syndrome in the early period after cardiac surgery
Acute kidney injury can greatly increase the severity of multiple organ dysfunction syndrome (MODS) and impair patient outcomes. Objective: To study the clinical significance of acute kidney injury in patients with MODS in early postoperative period after cardiac surgery and its influence on the severity of the patient condition and outcomes. Materials and methods: The study involved 117 patients aged 57.2 ± 1.2 years. The Group 1, control, included 74 patients with uncomplicated postoperative period; the Group 2 - 43 patients with MODS, who were divided into the survivors (33 patients, group 2a) and deaths (10 patients, group 2b). Results: In Group 2, the following parameters were higher - the volume of blood loss by 1.5 times (p = 0,001), the duration of the cardiopulmonary bypass 1.7 times (p = 0.001), and aortic clamping 1.6 times (p = 0,001). Group 2a and 2b on these indicators did not differ. Average scale Group 2b was 1,3-fold higher than in survivors (p = 0,001). Patients differ in the severity of the central nervous system disorders (the average score of Glasgow Coma Scale survivors was 1.3 times higher P = 0,001) and severity of acute kidney injury. On a RIFLE scale patients of group 2a normal data was observed in 12%, the stage of risk in 61%, and damage in 27%. In 50% of the dead was a stage of disease (p = 0,04), the rest - damage. In the dynamics of the group 2b impaired renal and hepatic functions have progressed. By day 3 AST was on average 2-fold higher (p = 0.01), ALT (1.9 fold, p = 0,001), alkaline phosphatase 1.5 times (p = 0,001), while the total blood protein below 1.3 times (p = 0.001), than in group 2a. Creatinine in patients of Group 2b was 1.4 times higher (p = 0,036), urea 1.6 (p = 0,026), u-NGAL 7 times higher (p = 0,001), than in group 2a. Conclusions: Long cardiopulmonary bypass, clamping of the aorta and a large amount of perioperative blood loss in cardiac patients determine the risk of MODS in the early postoperative period, but do not affect the outcome. On the background of the development of MODS an average score on MODS-2 scale died was 1.3 times higher in Group 2b than in survivors. Marked renal dysfunction in cardiac surgical patients with MODS is a sign of poor prognosis. With the development of MODS, a renal dysfunction ahead worsens hepatic function. The value of the marker u-NGAL is the strongest indicator of the severity of acute kidney injury and poor outcome of treatment in these patients.
About the authorsEremenko A.A.
Minbolatova Natal’ya M.
Karkouti K., Wijeysundera D.N. et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation. 2009; 119 (4): 495-502.
Maccariello E., Soares M., Valente C., Nogueira L., Valenca R.V., Machado J.E., Rocha E. RIFLE classification in patients with acute kidney injury in need of renal replacement therapy. Intensive Care Med. 2007; 33: 597-605.
Mehta R.L., Pascual M.T., Soroko S., Savage B.R., Himmelfarb J., Ikizler T.A. et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004; 66 (4): 1613-21.
Oppert M., Engel C., Brunkhorst F.M., Bogatsch H., Reinhart K., Frei U. et al. Acute renal failure in patients with severe sepsis and septic shock - a significant independent risk factor for mortality: results from the German Prevalence Study. Nephrol. Dial. Transplant. 2008; 23: 904-9.
Okusa M.D., Chertow G.M., Poryilla D. A basic science view of acute kidney injury biomarker. Nefrol. Dial. Transplant. 2014; 29: 1301-11.
Palevsky P.M., Zhang J.H., O’Connor T.Z., Chertow G.M., Crowley S.T., Choudhury D. et al. Intensity of renal support in critically ill patients with acute kidney injury. N. Engl. J. Med. 2008; 359: 7-20.
Rosner M.H., Okusa M.D.: Acute kidney injury associated with cardiac surgery. Clin. J. Am. Soc. Nephrol. 2006; 1 (1): 19-32.
Ricci Z., Villa G., Ronco C. Management of AKI: the role of biomarkers. In the book Vincent J.L. Annual Update in Intensive Care and Emergency Medicine. 2015; 367-73.
Sharshar T., Gray F., Porn F. et al. Multifocal necrotizing leukoencephalopathy in septic shock. Crit. Care Med. 2002; 30: 2371-5.
Silvester W., Bellomo R., Cole L. Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia. Crit. Care Med. 2001; 29: 1910-5.
Uchino S., Kellum J.A., Bellomo R., Doig G.S., Morimatsu H., Morgera S. et al. Acute renal failure in critically ill patients: a multinational, multicenter study. J.A.M.A. 2005; 294: 813-8.
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