Ultrasound Hepatic Vein Ratios Are Associated With the Development of Acute Kidney Injury After Cardiac Surgery

Pettey, Gabriela; Hermansen, Johan Fridolf; Nel, Samantha; Moutlana, Hlamatsi Jacob; Muteba, Michel; Juhl-Olsen, Peter; Tsabedze, Nqoba; Chakane, Palesa Motshabi

doi:10.1053/j.jvca.2021.07.039

Cited by 9 publications

(10 citation statements)

References 56 publications

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“…Although the American College of Radiology Appropriateness Criteria gives ultrasound the highest rating in the initial evaluation of AKI [ 25 ], the role of ultrasound in the diagnosis and management of AKI has still been explored in limited studies, and a majority of them were about the application of the contrast-enhanced ultrasound because of the advantage that it can provide quantitative assessments of renal perfusion, which may be concerned with AKI associated with vascular or hemodynamic changes [ 26 , 27 , 28 , 29 ]. A recent study also investigated the association between hepatic venous and right-heart ultrasound parameters and the risk of CSA-AKI, and found that the hepatic vein flow ratios were independently associated with the development of postoperative CSA-AKI [ 30 ]. In addition to the diagnosis of AKI, the role of ultrasound in the management of AKI patients may be controversial to some extent.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of the Transthoracic Echocardiography Index for Acute Kidney Injury after Cardiac Valve Surgery

Guo

Cao

et al. 2022

JCDD

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Background: We aimed to demonstrate whether the preoperative transthoracic echocardiography index (TTEI) could improve the predictive value of clinical parameters for cardiac valve surgery-associated acute kidney injury (CVS−AKI). Methods: A total of 213 patients who underwent surgical CVS at Renmin Hospital of Wuhan University were consecutively recruited in this retrospective study. TTE assessments were performed within 7 days before surgery and logistic regression was used to determine TTEI. A nomogram was constructed by integrating TTEI and clinical features, and the net reclassification index (NRI) and integrated discrimination improvement (IDI) were applied to evaluate the improvement in TTEI for CVS−AKI. Results: Among them, 66 patients (30.9%) developed CVS−AKI. The TTEI was calculated as follows: −6.579 + 0.068 × pulmonary artery systolic pressure (mmHg) −0.742 × LVEF (>55%, yes or no) + 0.346 × left ventricle posterior wall thickness (mm). The nomogram based on the TEEI and other clinical factors possessed excellent performance (C-index = 0.880), had great calibration and discrimination, and was clinically useful. Furthermore, NRI (0.07, 95% confidence interval, 95%CI, 0.01–0.12, p = 0.02) and IDI (0.08, 95%CI, 0.01–0.20, p = 0.02) indicated that TTEI could significantly improve the predictive value of clinical features for CVS−AKI. Conclusions: As a simple access and cost-effective parameter, the preoperative TTEI may be a reliable and useful factor for CVS−AKI.

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Section: Discussionmentioning

confidence: 99%

Predictive Value of the Transthoracic Echocardiography Index for Acute Kidney Injury after Cardiac Valve Surgery

Guo

Cao

et al. 2022

JCDD

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“…In severe congestion, there is a retrograde systolic component (opposite to the diastolic component). Abnormal postoperative hepatic vein blood flow waveform is associated with the occurrence of CSA-AKI [ 34 ]. In addition, a recent study suggests that the preoperative ratio of VTI of the retrograde and anterograde waves of the hepatic veins is independently correlated with increased creatinine levels after cardiac surgery [ 35 ].…”

Section: Definition and Diagnosismentioning

confidence: 99%

Diagnosis, pathophysiology and preventive strategies for cardiac surgery-associated acute kidney injury: a narrative review

Zhu

et al. 2023

Eur J Med Res

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Acute kidney injury (AKI) is a common and serious complication of cardiac surgery and is associated with increased mortality and morbidity, accompanied by a substantial economic burden. The pathogenesis of cardiac surgery-associated acute kidney injury (CSA-AKI) is multifactorial and complex, with a variety of pathophysiological theories. In addition to the existing diagnostic criteria, the exploration and validation of biomarkers is the focus of research in the field of CSA-AKI diagnosis. Prevention remains the key to the management of CSA-AKI, and common strategies include maintenance of renal perfusion, individualized blood pressure targets, balanced fluid management, goal-directed oxygen delivery, and avoidance of nephrotoxins. This article reviews the pathogenesis, definition and diagnosis, and pharmacological and nonpharmacological prevention strategies of AKI in cardiac surgical patients.

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“…Conventional measures of systemic circulation, such as right atrial filling pressure and its surrogate central venous pressure (CVP) have been used in clinical practice so far, as markers of systemic venous congestion (3,5,(7)(8)(9)(10). Over the past years, advancements in bedside critical care echography have provided novel, noninvasive methods to assess fluid overload and venous congestion, such as pulsatility of flow in the portal vein (11)(12)(13) and flow patterns in the hepatic (13)(14)(15) and the intrarenal (11,13,16) veins.…”

Section: Introductionmentioning

confidence: 99%

Early Trajectory of Venous Excess Ultrasound Score Is Associated With Clinical Outcomes of General Icu Patients

Trigkidis,

Siempos,

Kotanidou

et al. 2024

Shock

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Background Systemic venous congestion, assessed by the venous excess ultrasound (VExUS) score, has been associated with adverse effects, including acute kidney injury (AKI), in patients with cardiac disease. In general intensive care unit (ICU) patients, the association between VExUS score and outcomes is understudied. We aimed to investigate the association between the trajectory of VExUS score within first 3 days of ICU admission and the composite clinical outcome of major adverse kidney events within 30 days (MAKE30). Methods In this prospective observational study, including patients consecutively admitted to the ICU, VExUS score was calculated within 24 h following ICU admission (Day 1) and at 48-72 h (Day 3). D-VExUS was calculated as the difference between the VExUS score on Day 3 minus that on Day 1. Development of AKI within 7 days and all-cause mortality within 30 days were recorded. Results A total of 89 patients (62% males; median age 62 years; median APACHE II score 24) were included. Sixty (67%) patients developed AKI within 7 days and 17 (19%) patients died within 30 days following ICU admission. D-VexUS was associated with MAKE30, even after adjustment for confounders (hazard ratio 2.07, 95% CI:1.17-3.66; p = 0.01). VExUS scores on Days 1 or 3 were not associated with MAKE30. Also, VExUS scores on Day 1 or on Day 3 and D-VExUS were not associated with development of AKI or mortality. Conclusions In a general ICU cohort, early trajectory of VExUS score, but not individual VExUS scores at different time points, was associated with the patient-centered MAKE30 outcome. Dynamic changes rather than snapshot measurements may unmask the adverse effects of systemic venous congestion on important clinical outcomes.

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Ultrasound Hepatic Vein Ratios Are Associated With the Development of Acute Kidney Injury After Cardiac Surgery

Cited by 9 publications

References 56 publications

Predictive Value of the Transthoracic Echocardiography Index for Acute Kidney Injury after Cardiac Valve Surgery

Predictive Value of the Transthoracic Echocardiography Index for Acute Kidney Injury after Cardiac Valve Surgery

Diagnosis, pathophysiology and preventive strategies for cardiac surgery-associated acute kidney injury: a narrative review

Early Trajectory of Venous Excess Ultrasound Score Is Associated With Clinical Outcomes of General Icu Patients

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