Association of intraoperative cerebral and somatic tissue oxygen saturation with postoperative acute kidney injury in adult patients undergoing multiple valve surgery

Background A significant association between muscular tissue oxygen saturation (SmtO2), measured by near-infrared spectroscopy (NIRS), and postoperative complications has been observed in patients undergoing major surgery. However, the association between muscular tissue desaturation and acute kidney injury (AKI) has not yet been reported in patients following surgery for acute type A aortic dissection. Method One hundred seventy-four adult patients who underwent total aortic arch replacement (TAAR) under cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) for acute type A aortic dissection were retrospectively analyzed. Muscular tissue oxygen saturation (SmtO2) and regional cerebral oxygen saturation (rScO2), measured by NIRS, were recorded. The baseline SmtO2 and rScO2 were the average values over 30 seconds following anesthesia induction. The minimum SmtO2 and rScO2 values were the lowest measurements recorded at any time during surgery. The mean SmtO2 and rScO2 were the average values across the entire monitoring period. The thresholds defining muscular tissue desaturation were SmtO2 < 80%, < 85%, and < 90% of baseline (relative changes compared to the baseline measurement) and < 55% and < 50% (absolute values). Cerebral desaturation was defined as rScO2 falling below 55% or 50% on either the left or right side during surgery. The primary outcome was the association between muscular tissue desaturation and AKI. The secondary outcome was the association between cerebral desaturation and AKI. Result AKI occurred in 71 (40.08%) of the 174 patients underwent TAAR under CPB and DHCA. SmtO2 < 80% of baseline was associated with an increased risk of AKI (odds ratio [OR], 1.021; 95% confidence interval [CI], 1.001–1.041; P = 0.034). A receiver operating characteristic curve showed that the optimal cutoff for SmtO2 < 80% baseline duration was 33.5 minutes in predicting AKI (sensitivity, 70.00%; specificity, 77.80%). The durations of SmtO2 < 85% baseline (OR, 1.009; 95% CI, 0.996–1.021; P = 0.195) and < 90% baseline (OR,1.007; 95% CI, 0.996–1.018; P = 0.208) were not significantly associated with AKI. There were no significant differences in the durations of absolute SmtO2 values < 55% and < 50% or in the minimum SmtO2 between the two cohorts. Minimum rScO2 and durations of left and right rScO2 < 55% and < 50% were also not associated with AKI. Patients with AKI experienced significantly higher in-hospital mortality and more postoperative complications compared with non-AKI patients. Conclusion Muscular tissue desaturation, defined as SmtO2 < 80% of baseline monitored on the lower leg, was significantly associated with an increased risk of AKI in patients who underwent TAAR under CPB and DHCA. Cerebral desaturation, defined as absolute rScO2 < 55% or < 50%, was not associated with AKI.

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Association of intraoperative cerebral and somatic tissue oxygen saturation with postoperative acute kidney injury in adult patients undergoing multiple valve surgery

Cited by 4 publications

References 36 publications

Measurement of Oxygen Metabolism and Renal Perfusion for Early Prediction of Acute Kidney Injury

Measurement of Oxygen Metabolism and Renal Perfusion for Early Prediction of Acute Kidney Injury

The Association Between Renal Desaturation Measured Using Near-Infrared Spectroscopy and Postoperative Acute Kidney Injury: A Systematic Review

Association between muscular tissue desaturation and acute kidney injury in patients after surgery for acute type A aortic dissection: a single-center retrospective study

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