Stanislas Abrard, Antoine Streichenberger, Jérémie Riou, Jeanne Hersant, Emmanuel Rineau, Matthias Jacquet-Lagrèze, Olivier Fouquet, Samir Henni, Thomas Rimmelé
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Preoperative microcirculation was assessed during preoperative consultation from January 2019 to April 2019 at the University Hospital of Angers, France, using endothelium-dependent and endothelium-independent reactivity tests on the forearm (iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), respectively). Skin blood flow was measured by laser speckle contrast imaging. The primary endpoint was the occurrence of AKI according to the KDIGO classification during the hospital stay.</p><p><strong>Results: </strong>Forty-three (71.7%) patients developed AKI during the in-hospital follow-up, and 15 (25%) were classified as KDIGO stage 1, 20 (33%) KDIGO stage 2, and 8 (13%) KDIGO stage 3. Regarding preoperative microcirculation, a higher peak amplitude of vasodilation in response to iontophoresis of ACh was found in patients with postoperative occurrence of AKI (35 [20-49] vs 23 [9-44] LSPU, p = 0.04). Iontophoresis of SNP was not significantly different according to AKI occurrence (34 [22-49] vs 36 [20-50] LSPU, p = 0.95). In a multivariable model, the preoperative peak amplitude at iontophoresis of ACh was independently associated with postoperative AKI (OR 1.045 [1.001-1.092], p = 0.045).</p><p><strong>Conclusions: </strong>The preoperative peak amplitude of endothelium-dependent vasodilation is independently associated with the postoperative occurrence of AKI.</p><p><strong>Trial registration: </strong>Clinical-Trials.gov, NCT03631797. 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The primary endpoint was the occurrence of AKI according to the KDIGO classification during the hospital stay.</p><p><strong>Results: </strong>Forty-three (71.7%) patients developed AKI during the in-hospital follow-up, and 15 (25%) were classified as KDIGO stage 1, 20 (33%) KDIGO stage 2, and 8 (13%) KDIGO stage 3. Regarding preoperative microcirculation, a higher peak amplitude of vasodilation in response to iontophoresis of ACh was found in patients with postoperative occurrence of AKI (35 [20-49] vs 23 [9-44] LSPU, p = 0.04). Iontophoresis of SNP was not significantly different according to AKI occurrence (34 [22-49] vs 36 [20-50] LSPU, p = 0.95). 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引用次数: 0
摘要
背景：多达 42% 的患者在心脏手术后会出现急性肾损伤 (AKI)。本研究旨在描述使用心肺旁路（CPB）进行心脏手术后，术前微循环功能与术后 AKI 之间的关系：前瞻性观察队列 MONS 共纳入 60 名计划使用 CPB 进行瓣膜手术（30 人，50%）或冠状动脉手术（30 人，50%）的患者。2019年1月至2019年4月在法国昂热大学医院进行术前咨询时，使用前臂内皮依赖性和内皮非依赖性反应测试（分别为乙酰胆碱（ACh）和硝普钠（SNP）离子透入法）对术前微循环进行了评估。通过激光斑点对比成像测量皮肤血流量。主要终点是住院期间根据 KDIGO 分级出现的 AKI：结果：43 例（71.7%）患者在院内随访期间出现了 AKI，其中 15 例（25%）被分为 KDIGO 1 期，20 例（33%）为 KDIGO 2 期，8 例（13%）为 KDIGO 3 期。关于术前微循环，发现术后发生 AKI 的患者对 ACh 离子注入的血管扩张峰值振幅更高（35 [20-49] vs 23 [9-44] LSPU，P = 0.04）。发生 AKI 的患者对 SNP 的离子透入无明显差异（34 [22-49] vs 36 [20-50] LSPU，p = 0.95）。在多变量模型中，ACh离子透入时的术前峰值振幅与术后AKI独立相关（OR 1.045 [1.001-1.092]，P = 0.045）：结论：术前内皮依赖性血管扩张的峰值振幅与术后发生 AKI 独立相关：试验注册：Clinical-Trials.gov，NCT03631797。注册时间：2018年8月15日，https://clinicaltrials.gov/ct2/show/NCT03631797。
Preoperative endothelial dysfunction for the prediction of acute kidney injury after cardiac surgery using cardiopulmonary bypass: a pilot study based on a second analysis of the MONS study.
Background: Up to 42% of patients develop acute kidney injury (AKI) after cardiac surgery. The aim of this study was to describe the relationship between preoperative microcirculatory function and postoperative AKI after cardiac surgery using cardiopulmonary bypass (CPB).
Methods: The prospective observational cohort MONS enrolled 60 patients scheduled for valvular (n = 30, 50%) or coronary (n = 30, 50%) surgery using CPB. Preoperative microcirculation was assessed during preoperative consultation from January 2019 to April 2019 at the University Hospital of Angers, France, using endothelium-dependent and endothelium-independent reactivity tests on the forearm (iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), respectively). Skin blood flow was measured by laser speckle contrast imaging. The primary endpoint was the occurrence of AKI according to the KDIGO classification during the hospital stay.
Results: Forty-three (71.7%) patients developed AKI during the in-hospital follow-up, and 15 (25%) were classified as KDIGO stage 1, 20 (33%) KDIGO stage 2, and 8 (13%) KDIGO stage 3. Regarding preoperative microcirculation, a higher peak amplitude of vasodilation in response to iontophoresis of ACh was found in patients with postoperative occurrence of AKI (35 [20-49] vs 23 [9-44] LSPU, p = 0.04). Iontophoresis of SNP was not significantly different according to AKI occurrence (34 [22-49] vs 36 [20-50] LSPU, p = 0.95). In a multivariable model, the preoperative peak amplitude at iontophoresis of ACh was independently associated with postoperative AKI (OR 1.045 [1.001-1.092], p = 0.045).
Conclusions: The preoperative peak amplitude of endothelium-dependent vasodilation is independently associated with the postoperative occurrence of AKI.
Trial registration: Clinical-Trials.gov, NCT03631797. Registered 15 August 2018, https://clinicaltrials.gov/ct2/show/NCT03631797.
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