Mitochondrial oxygenation monitoring and acute kidney injury risk in cardiac surgery: A prospective cohort study

被引：0
作者：
de Wijs, Calvin J. [1 ]
Streng, Lucia W. J. M. [1 ]
Stolker, Robert Jan [1 ]
ter Horst, Maarten [1 ]
Hoorn, Ewout J. [2 ]
Mahtab, Edris A. F. [3 ]
Mik, Egbert G. [1 ]
Harms, Floor A. [1 ]
机构：
[1] Erasmus MC, Dept Anesthesiol, Lab Expt Anesthesiol, Rotterdam, Netherlands
[2] Erasmus MC, Dept Internal Med, Rotterdam, Netherlands
[3] Erasmus MC, Dept Cardiothorac Surg, Rotterdam, Netherlands
来源：
JOURNAL OF CLINICAL ANESTHESIA | 2025年 / 101卷
关键词：
Acute kidney injury; Mitochondrial oxygenation; Cardiac surgery; Coronary artery bypass grafting; CELL TRANSFUSION; PO2; TENSION; ANEMIA;
D O I：
10.1016/j.jclinane.2024.111715
中图分类号：
R614 [麻醉学];
学科分类号：
100217 ;
摘要：
Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication of cardiac surgery and is associated with increased morbidity and mortality. Recent guidelines emphasize the need for new monitoring methods to facilitate targeted CSA-AKI prevention and treatment strategies. In vivo real-time measurement of mitochondrial oxygen tension (mitoPO(2)), could potentially fulfil this role during cardiac surgery, as suggested in our previous pilot study. Methods: In this prospective observational study, we investigated 75 cardiac surgery patients with an increased preoperative CSA-AKI risk. The primary aim of this study was to assess whether patients who developed CSA-AKI experienced prolonged periods of mitoPO(2) < 20 mmHg during surgery. mitoPO(2) was measured intraoperatively, and CSA-AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Four additional mitoPO(2) thresholds (<25, <30, <35, and < 40 mmHg) were analyzed, including the predictive capacity of all thresholds for CSA-AKI. Results: This study found that patients who developed CSA-AKI had a significantly longer intraoperative time with mitoPO(2) <20 mmHg and <25, <30, <35, and <40 mmHg. Subsequently, we tested all thresholds for their association with the risk of CSA-AKI, with the <25 mmHg threshold demonstrating the highest significant odds ratio. Every minute spent below <25 mmHg increased the risk of CSA-AKI by 0.7 % (P = 0.021). Conclusions: This study highlighted the association between mitoPO(2) and the onset of CSA-AKI. Extended durations below the mitoPO(2) threshold of 25 mmHg significantly correlate with an elevated CSA-AKI risk. Using mitoPO(2) as a monitoring tool shows promise in potentially predicting and possibly preventing CSA-AKI when used as a treatment trigger in cardiac surgery patients.
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页数：8
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