Biomarkeri akutnog oštećenja bubrega nakon kardiohirurških operacija odraslih pacijenata
Acute kidney injury biomarkers after cardiac surgery in adult patients
Author
Radović, Mina M.Mentor
Velinović, MilošCommittee members
Simić-Ogrizović, SanjaLežaić, Višnja
Vraneš, Mile
Pavlović, Aleksandar
Metadata
Show full item recordAbstract
Kardiohirurške operacije izvedene uz kardiopulmonalni by-pass (CPB) su
drugi najčešći uzrok AOB, što je povezano sa porastom mortaliteta, morbiditeta i
dužinom hospitalizacije. AOB udruženo sa kardiohirurškim procedurama (CSA-AKI)
karakteriše naglo pogoršanje funkcije bubrega, koje nastaje pod uticajem raznih
faktora kao što su: ishemijsko-reperfuziona oštećenja, metaboličke abnormalnosti,
aktivacija neurohumoralnog odgovora, zapaljenski i oksidativni stres kao i egzogeni i
endogeni toksini. Incidenca pojave CSA-AKI je između 8,9% i 39%.
Cilj: Utvrđivanje incidence, značaja opštih karakteristika, specifičnih parametara
vezanih za CPB, standardnih laboratorijskih, gasnih i analiza acidobaznog statusa,
standardnih pokazatelja bubrežne funkcije i novih biomarkera bubrežnog oštećenja
(KIM-1 i u-NGAL) u nastanku, ranom otkrivanju i predikciji akutnog oštećenja
bubrega kod elektivnih kardiohirurških operacija.
Bolesnici i metode: Ova prospektivna, opservaciona studija uključuje 100 odraslih
...niskorizičnih bolesnika za razvoj AOB, planiraih za izvođenje elektivnih
kardiohirurških intervencija uz primenu CPB-a: aortokoronarnog by-passa, valvularne
hirurgije i kombinovanih procedura (koronarna i valvularna hirurgija). Svim
bolesnicima su preoperativno prikupljeni anamnestički podaci, obavljen je fizikalni
pregled, izmereni hemodinamski parametri i zabeležena ejekciona frakcija (EF).
Izvršena je klasifikacija bolesnika po NYHA protokolu i procenjen je operativni rizik
za razvoj AOB primenom dva skora: Cleveland Clinic score (CCS) i Leicester
Cardiac Surgery Research AKI Risk Score kalkulatora (LCSRARS)...
Cardiac surgery procedures with cardiopulmonary by-pass (CPB) are
the second most common cause of Acute Kidney Injury (AKI), which is connected
with the increase of mortality, morbidity and the length of hospitalization. AKI
associated with cardiovascular procedures (CSA-AKI) is characterized by rapid
deterioration of kidney function, which is caused by various factors such as: ischemicreperfusion
injury, metabolic abnormalities, activation of neurohumoral response,
inflammatory and oxidative stress, as well as exogenous and endogenous toxins. The
incidence of CSA-AKI is between 8.9% and 39%.
Goal: Determination of incidence and the significance of general characteristics,
specific parameters related to cardiopulmonary by-pass, standard laboratory, gas and
acid-base status analysis, standard renal function indicators and novel biomarkers of
kidney injury (KIM-1 and u-NGAL) in emergence, early detection and the prediction
of acute kidney injury in elective cardiac surgery procedures.
Pa...tients and Methods: This prospective, observational study included 100 adult,
low-risk patients for Acute Kidney Injury (AKI) development, planned for elective
cardiac surgery with cardio pulmonary bypass (CPB): aortocoronary bypass surgery,
heart valve surgery and combined procedures (coronary and heart valve surgery). All
patients were preoperatively examined, anamnestic data were collected, physical
examination performed, hemodynamic parameters measured and ejection fraction
recorded. The classification of patients under the NYHA protocol was performed and
the operational risk for the development of AKI was evaluated using two scores:
Cleveland Clinic score (CCS) and Leicester Cardiac Surgery Research AKI Risk
Score (LCSRARS).
The blood and urine samples were taken the day before operation, shortly before or
immediately after CPB, as well as 3h, 12h, 24h and 48h after the CPB was performed...