Preoperative right heart hemodynamics predict postoperative acute kidney injury after heart transplantation

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dc.contributor.authorGuven, Goksel
dc.contributor.departmentTıp Fakültesitr_TR
dc.date.accessioned2021-01-05T07:36:39Z
dc.date.available2021-01-05T07:36:39Z
dc.date.issued2018
dc.description.abstractPurpose: Acute kidney injury (AKI) frequently occurs after heart transplantation (HTx), but its relation to preoperative right heart hemodynamic (RHH) parameters remains unknown. Therefore, we aimed to determine their predictive properties for postoperative AKI severity within 30 days after HTx. Methods: From 1984 to 2016, all consecutive HTx recipients (n = 595) in our tertiary referral center were included and analyzed for the occurrence of postoperative AKI staged by the kidney disease improving global outcome criteria. The effects of preoperative RHH parameters on postoperative AKI were calculated using logistic regression, and predictive accuracy was assessed using integrated discrimination improvement (IDI), net reclassification improvement (NRI), and area under the receiver operating characteristic curves (AUC). Results: Postoperative AKI occurred in 430 (72%) patients including 278 (47%) stage 1, 66 (11%) stage 2, and 86 (14%) stage 3 cases. Renal replacement therapy (RRT) was administered in 41 (7%) patients. Patients with higher AKI stages had also higher baseline right atrial pressure (RAP; median 7, 7, 8, and in RRT 11 mmHg, p trend = 0.021), RAP-to-pulmonary capillary wedge pressure ratio (median 0.37, 0.36, 0.40, 0.47, p trend = 0.009), and lower pulmonary artery pulsatility index (PAPi) values (median 2.83, 3.17, 2.54, 2.31, p trend = 0.012). Higher RAP and lower PAPi values independently predicted AKI severity [adjusted odds ratio (OR) per doubling of RAP 1.16 (1.02-1.32), p = 0.029; of PAPi 0.85 (0.75-0.96), p = 0.008]. Based on IDI, NRI, and delta AUC, inclusion of these parameters improved the models' predictive accuracy. Conclusions: Preoperative PAPi and RAP strongly predict the development of AKI early after HTx and can be used as early AKI predictors.tr_TR
dc.description.indexPubmed
dc.identifier.endpage597tr_TR
dc.identifier.issue5tr_TR
dc.identifier.startpage588tr_TR
dc.identifier.urihttps://doi.org/10.1007/s00134-018-5159-ztr_TR
dc.identifier.urihttp://hdl.handle.net/20.500.12575/72628
dc.identifier.volume44tr_TR
dc.language.isoentr_TR
dc.relation.isversionof10.1007/s00134-018-5159-ztr_TR
dc.relation.journalIntensive Care Med .tr_TR
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıtr_TR
dc.subjectAcute kidney injurytr_TR
dc.subjectHeart transplantationtr_TR
dc.subjectMortalitytr_TR
dc.titlePreoperative right heart hemodynamics predict postoperative acute kidney injury after heart transplantationtr_TR
dc.typeArticletr_TR

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