Low Intraoperative Cerebral Oxygen Saturation Is Associated with Acute Kidney Injury after Off-Pump Coronary Artery Bypass

By monitoring the brain as the index organ of global oxygen supply-demand balance including major organs, regional cerebral oxygen saturation (rScO(2)) may indicate adequacy of renal perfusion. The aim of this study was to investigate the relationship between perioperative rScO(2) and acute kidney injury (AKI) after off-pump coronary artery bypass (OPCAB). AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes criteria. Collected rScO(2) variables were baseline, mean, and lowest value during surgery, maximal percentage decrease from baseline, and areas under the threshold below an absolute value of 50% (AUT(50)) and of 80% of baseline (AUT(80%base)). Among 580 patients, AKI developed in 143 (24.7%) patients. Patients with AKI had lower baseline, mean, and lowest rScO(2) and higher AUT(50) and AUT(80%base) than those without AKI despite routine efforts to restore the rScO(2) values within 20% of the baseline. Among the rScO(2) variables, the area under the receiver operating characteristic curve of mean rScO(2) was the highest (0.636), which was used for the multivariable logistic regression. Multivariable logistic regression revealed mean rScO(2) as an independent predictor of AKI (odds ratio, 0.964; 95% confidence interval, 0.937-0.990; p = 0.008), along with chronic kidney disease and emergency surgery. Low intraoperative mean rScO(2) was independently associated with AKI after OPCAB, which may serve as an early marker of renal injury.