High estimated pulmonary artery systolic pressure (ePASP) has been established as a detrimental predictor for adverse outcomes in patients with chronic kidney disease. However, the relation between preoperative high ePASP and the development of cardiac surgery associated acute kidney injury (CSA-AKI) has not been validated. We performed a retrospective cohort study of adult patients who underwent valve surgery in 2015 at Zhongshan Hospital, Fudan University. Right ventricular systolic pressure, a surrogate for pulmonary systolic pressure, was estimated in the study group of 1056 patients by preoperative echocardiography. CSA-AKI was defined based on the Kidney Disease Improving Global Outcomes criteria. The relation between preoperative ePASP and CSA-AKI was demonstrated with the use of multivariate analysis after adjusting for potential risk factors for CSA-AKI. Of these patients, preoperative ePASP was 44.5 +/- 14.9 mm Hg. 401 (38%) patients developed CSA-AKI in which 73 patients (6.9%) suffered from severe AKI (stage II and III). Multivariate analysis showed that preoperative ePASP was independently associated with CSA-AKI (odds ratio per 10 mm Hg increment, 1.099; 95% confidence interval, 1.003 to 1.204; p = 0.042). Preoperative ePASP more than 60 mm Hg was found to be linked with the increasing incidence of AKI by 62% and in-hospital mortality by over 300%, but not linked with severe AKI or renal replacement therapy. In conclusion, an increase in preoperative ePASP was independently and significantly associated with the development of CSA-AKI in patients who underwent valve surgery. Such relation between preoperative ePASP and CSA-AKI could provide a novel therapeutic target against prevention of AKI. (C) 2018 Published by Elsevier Inc.
[1]Fudan Univ, Shanghai Med Coll, Zhongshan Hosp, Dept Nephrol, Shanghai, Peoples R China;
[2]Fudan Univ, Zhongshan Hosp, Shanghai Med Coll, Dept Cardiol, Shanghai, Peoples R China;
[3]Fudan Univ, Shanghai Med Coll, Zhongshan Hosp, Dept Cardiac Surg,Intens Care Unit, Shanghai, Peoples R China;
[4]Fudan Univ, Shanghai Med Coll, Zhongshan Hosp, Dept Cardiovasc Surg, Shanghai, Peoples R China;
[5]Shanghai Med Ctr Kidney Dis, Shanghai, Peoples R China;
[6]Shanghai Inst Kidney & Dialysis, Shanghai, Peoples R China;
[7]Shanghai Key Lab Kidney & Blood Purificat, Shanghai, Peoples R China
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