PREOPERATIVE HEMOGLOBIN AND URIC ACID LEVELS AS RISK FACTORS FOR ACUTE KIDNEY INJURY IN CARDIAC SURGERY PATIENTS/PREOPERATIVNE VREDNOSTI HEMOGLOBINA I MOKRACNE KISELINE KAO FAKTORI RIZIKA ZA AKUTNO OSTECENJE BUBREGA KOD KARDIOHIRURSKIHPACIJENATA

• Published in: Medicinski pregled Vol. 73; no. 1-2; p. 5
• Main Authors: Golubovic, Miodrag, Preveden, Andrej, Zdravkovic, Ranko, Vidovic, Jelena, Mihajlovic, Bojan, Rajic, Jovan
• Format: Journal Article
• Language: English
• Published: Drustvo Lekara Vojvodine 01.01.2020
• Subjects: C-reactive protein; Cardiac patients; Creatine; Creatine kinase; Enzymes; Glycosylated hemoglobin; Health aspects; Medical records; Medical research; Mortality; Surgery; Uric acid
• ISSN: 0025-8105
• DOI: 10.2298/MPNS2002005G

Introduction. Acute kidney injury associated with cardiac surgery is a common and significant postoperative complication. With a frequency of 9 - 39% according to different studies, it is the second most common cause of acute kidney injury in intensive care units, and an independent predictor of mortality. This study aimed to investigate the importance of preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in the postoperative period in cardiac surgery patients. Material and Methods. The study included a total of 118 patients who were divided into two groups. Each group included 59 patients; the fist group included patients who developed acute kidney injury and required renal replacement therapy, and the second included patients without acute kidney injury. Types of cardiac surgery included coronary, valvular, combined, aortic dissection, and others. All necessary data were collected from patient medical records and the electronic database. Results. A statistically significant difference was found between the groups in preoperative hemoglobin levels (108.0 vs. 143.0 g/l, p = 0.0005); postoperative urea (26.4 vs. 5.8 mmol/l, p = 0.0005) and creatinine (371.0 vs. 95.0 [micro]mol/l, p = 0.0005), acute phase inflammatory reactants C-reactive protein (119.4 vs. 78.9 mg/l, p = 0.002) and procalcitonin (7.0 vs. 0.2 ng/ml, p = 0.0005), creatine kinase myocardial band isoenzyme (1045.0 vs. 647.0 mg/l, p = 0.014); duration of extracorporeal circulation (103.5 vs. 76.0 min, p = 0.0005) and ascending aortic clamp during cardiac surgery (89.0 vs. 67.0 min, p = 0.0005). The exception was the preoperative uric acid level, where there was no statistically significant difference (382.0 vs. 364.0 [micro]mol/l, p = 0.068). There was a statistically significant correlation between the use of inotropic agents and acute kidney injury development. Conclusion. There is a correlation between the preoperative low hemoglobin levels and postoperative acute kidney injury. There is no statistically significant correlation between the preoperative levels of uric acid and postoperative acute kidney injury. Key words: Acute Kidney Injury; Cardiac Surgical Procedures; Preoperative Care; Hemoglobins; Uric Acid; Risk Factors; Renal Replacement Therapy; Postoperative Complications Uvod. Akutno oštecenje bubrega udruženo sa kardiohirurškom operacijom cestaje i znacajna postoperativna komplikacija i sa ucestalošcu 9-39%, prema razlicitim studijama, predstavlja drugi najcešci uzrok akutnog zatajivanja bubrega u jedinicama intenzivne nege i nezavisan prediktor mortaliteta. Cilj ovog rada bio je da se ispita znacaj preope-rativnih vrednosti hemoglobina i mokracne kiseline kao faktora rizika za razvoj akutnog oštecenja bubrega u postoperativnom periodu kod kardiohirurških pacijenata. Materijal i metode. Istraživanjem je obuhvaceno ukupno 118 pacijenata, koji su podeljeni u dve grupe. Prvu grupu cinilo je 59 pacijenata koji su razvili akutno oštecenje bubrega i koji su zahtevali terapiju zamene bubrežne funkcije, a drugu grupu je cinilo 59 pacijenata bez akutnog oštecenja bubrega. Tipovi hirurgije bili su koronarna, valvularna, kombinovana, disekcija aorte i druge. Svi potrebni podaci o pacijentima su uzeti iz medicinske dokumentacije i iz elektronske medicinske baze podataka. Rezultati. Pronadena je statisticki znacajna razlika izmedu grupa u odnosu na vrednosti preoperativnog hemoglobina (108 vs 143 g/l, p = 0,0005); postoperativnih vrednosti uree (26,4 vs 5,8 mmol/l, p = 0,0005) i kreatinina (371 vs 95 [micro]mol/l, p = 0,0005), reaktanata akutne faze zapaljenja - C-reaktivni protein (119,4 vs 78,9 mg/l, p = 0,002) i prokalcitonina (7 vs 0,2 ng/ml, p = 0,0005), izoenzima CK-MB (1045 vs 647 mg/l, p = 0,014); kao i u vremenskom trajanju ekstrakorporalne cirkulacije (103,5 vs 760 min, p = 0,0005) i kleme ascendentne aorte (89 vs 67 min, p = 0,0005) tokom kardiohirurške operacije. Izuzetak su preoperativne vrednosti mokracne kiseline, gde izmedu ispitivanih grupa nije pronadena statisticki znacajna razlika (382 vs 364 [micro]mol/l, p = 0,068). Otkrivenaje statisticki znacajna korelacija izmedu upotrebe inotropnih lekova i razvoja akutnog oštecenja bubrega. Zakljucak. Postoji visok stepen korelacije izmedu preoperativnih niskih vrednosti hemoglobina i posleoperativne pojave akutnog oštecenja bubrega. Ne postoji statisticki znacajna korelacija izmedu preoperativnih vrednosti mokracne kiseline i posleoperativne pojave akutnog oštecenja bubrega. Kljucne reci: akutno oštecenje bubrega; kardiohirurške procedure; preoperativna priprema; hemoglobin; mokracna kiselina; faktori rizika; supstituciona terapija bubrežne funkcije; postoperativne komplikacije