Preoperatif Albumin Düzeyi, Pediatrik Kalp Cerrahisi Sonrası Akut Böbrek Hasarı ile İlişkili Değildir: Bir Retrospektif Kohort Çalışması
Fatma Ukil Işıldak1
, Yasemin Yavuz1, Ömer Faruk Şavluk1, Nihat Çine2, Ufuk Uslu1
1Department of Anesthesiology and Reanimation, Kartal Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
2Department of Pediatric Cardiovascular Surgery, Kartal Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
Anahtar Kelimeler: Konjenital kalp hastalığı; kalp cerrahisi; albumin; akut böbrek hasarı.
Özet
Giriş: Bu çalışmanın amacı, konjenital kalp hastalığı nedeniyle açık kalp cerrahisi geçiren pediatrik hastalarda akut böbrek hasarı (ABH) gelişiminin preoperatif albumin/prealbumin düzeyleri ve diğer klinik özellikler ile ilişkili olup olmadığını değerlendirmektir.
Hastalar ve Yöntem: Bu retrospektif kohorta, 1 Ocak 2018-31 Aralık 2020 tarihleri arasında İstanbul Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesinde konjenital kalp hastalığı tanısıyla açık kalp cerrahisi (tam düzeltme ameliyatı) geçiren 1-60 ay arası hastalar, geriye dönük olarak dahil edilmiştir (n= 100). Hastaların demografik özellikleri, tanıları, cerrahi özellikleri ve laboratuvar bulguları kaydedildi ve analiz edildi.
Bulgular: Ortalama yaş 13.63 ± 12.05 (dağılım 1.5-60) aydır. eGFR, olguların %13’ünde %50’den fazla azalmıştır. Preoperatif döneme göre üre (24 ve 48. saat) ve kreatinin düzeylerinin anlamlı olarak arttığı (her biri için p< 0.001) ve postoperatif dönemde eGFR’nin anlamlı olarak düştüğü (p< 0.001) saptanmıştır. EGFR değeri için oluşturulan regresyon modelinde, daha uzun aortik çapraz klemp süresinin (ACCT) eGFR’de daha büyük bir azalma ile ilişkili olduğu görülmüştür (p= 0.046). Modelde yer alan diğer değişkenler, yaş (p= 0.128), cinsiyet (p= 0.358), RACHS (p= 0.865), beden kitle indeksi (p= 0.862), prealbumin (p= 0.313), albumin (p= 0.806) ve kardiyopulmoner baypas süresi (p= 0.921) anlamlı bulunmamıştır.
Sonuç: Konjenital kalp hastalığı nedeniyle kalp cerrahisi geçiren hastalarda eGFR ile preoperatif albümin/ prealbumin düzeyleri arasında ilişki bulunmazken, daha uzun süre AKT’nin azalmış eGFR ile ilişkili olduğu bulunmuştur.
Sonuç
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