Comparison of Patient’s Kidney Function Based on Kidney Disease Improving Global Outcomes (KDIGO) Criteria and Clinical Parameters in Isolated Coronary Artery Bypass Graft (CABG) Surgery in On-Pump and Off-pump Methods in Patients with Low Cardiac Output Syndrome (LCOS) After Surgery

Abstract

Background Acute kidney injury (AKI) is one of the serious complications of cardiac surgery. It is worsened when accompanied by low cardiac output syndrome. Objectives In this study, we compared kidney function based on the KDIGO criteria in isolated on-pump and off-pump coronary artery bypass graft (CABG) surgery. Methods In this cohort study, 52 patients with LCOS were enrolled after on-pump (28 patients) and off-pump (24 patients) CABG. In the first six hours after ICU entrance, blood samples were taken for serum creatinine based on routine. For determining AKI after surgery, we used the KDIGO criteria as a primary endpoint. Also, some clinical parameters were recorded before, during, and after surgery. The data were analyzed by SPSS software, version 24, using paired and independent t -test, ANOVA, and Pearson correlation test and non-parametric tests such as Mann-Whitney and Kruskal-Wallis tests at a significance level of P < 0.05. Results There was no significant difference in age (P = 0.3) and gender (P = 0.57) between the two groups. Among cardiac disease risk factors, only hypertension (P = 0.02) had a significant difference between the two groups, but AKI in patients with hypertension did not show a significant difference (P = 0.09). In paraclinical parameters, serum creatinine showed a significant difference before and after surgery in on-pump (P < 0.001) and off-pump (P = 0.007) groups. Also, this parameter had a significant difference at 6 h, 12 h, 24 h, and 48 h after surgery between the on-pump and on-pump groups. The AKI incidence showed a significant difference between the two groups (P < 0.001). Conclusions The incidence of AKI was more in on-pump patients than in off-pump patients. Also, a significant difference was observed between their clinical parameters. Thus, to improve the patients’ clinical outcomes and lower the health costs, we suggest that patients with a high risk of LCOS be followed up after CABG, especially on-pump CABG.

Leucoglycemic index predicts post-operative vasopressor-inotropic requirement after adult cardiac surgery (LEUCOGLYPTICS): A retrospective single-center study

“…[ 23 ] Moreover, systemic inflammation and LCOS-vasoplegia-linked hypo-perfusion, in conjunction, predispose to morbid organ outcomes such as post-operative AKI. [ 24 25 ] Indeed, LGI was associated with a higher incidence of AKI in our study.…”

CSA-AKI: Incidence, Epidemiology, Clinical Outcomes, and Economic Impact

“…Contact of the circulating blood volume with the CPB circuit causes immune activation as evidenced by measurable increases in IL-6 (an inflammatory cytokine) and IL-10 (an anti-inflammatory cytokine), and, the higher the level of IL-6, the higher the corresponding risk of subsequent AKI [40]. In some studies, avoidance of CPB by "off-pump" techniques in CABG has been associated with lower rates of AKI, which will be discussed in more depth below [41][42][43].…”

Comparison of Bioimpedance Versus Pulse Contour Analysis for Intraoperative Cardiac Index Monitoring in Patients Undergoing Kidney Transplantation

“…Intraoperative low cardiac output and hypotension disrupt perfusion to the kidney that potentially causes graft failure, as well as maintaining perfusion within normal autoregulation, decrease the risk of organ complications in high-risk cardiac and non-cardiac surgical patients ( 22 , 23 ). In perioperative and intensive care medicine, static parameters such as central venous pressure (CVP) or mean arterial blood pressure (MAP) have limitations as hemodynamic monitoring in high-risk surgical patients ( 24 ).…”