Diuretic response after neonatal cardiac surgery: a report from the NEPHRON collaborative.
Background: Multicenter early diuretic response (DR) analysis of single furosemide dosing following neonatal cardiac surgery is lacking to inform whether early DR predicts adverse clinical outcomes. Methods: We performed a retrospective cohort study utilizing data from the NEPHRON registry. Random f...
| Publicado en: | Pediatric Nephrology Vol. 39; no. 9; pp. 2797 - 2806 |
|---|---|
| Autores principales: | , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Springer Nature
Sep2024
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=178622911&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 178622911 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0931041X EF1 jtl: Pediatric Nephrology issn: 0931041X maglogo: N pubinfo: dt: Sep2024 vid: 39 iid: 9 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 178622911 177077889 178622911 178622911 10.1007/s00467-024-06380-y 178622911 ppf: 2797 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Diuretic response after neonatal cardiac surgery: a report from the NEPHRON collaborative. aug: au: Blinder, Joshua J. Alten, Jeffrey Bailly, David Buckley, Jason Clarke, Shanelle Diddle, J. Wesley Garcia, Xiomara Gist, Katja M. Koch, Joshua Kwiatkowski, David M. Rahman, A. K. M. Fazlur Reichle, Garrett Valentine, Kevin Hock, Kristal M. Borasino, Santiago affil: Division of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, 94304, Palo Alto, CA, USA sug: subj: Cardiac Surgery In Infancy and Childhood Diuretics Therapeutic Use Diuretics Administration and Dosage Postoperative Complications Postoperative Care Hypervolemia Kidney Failure, Acute Human Funding Source Male Female Infant, Newborn Infant Multicenter Studies Retrospective Design Record Review Prospective Studies Random Forest Machine Learning ROC Curve Odds Ratio Respiration, Artificial Length of Stay Confidence Intervals Sensitivity and Specificity Infant, Newborn: birth-1 month Infant: 1-23 months Male Female ab: Background: Multicenter early diuretic response (DR) analysis of single furosemide dosing following neonatal cardiac surgery is lacking to inform whether early DR predicts adverse clinical outcomes. Methods: We performed a retrospective cohort study utilizing data from the NEPHRON registry. Random forest machine learning generated receiver operating characteristic-area under the curve (ROC-AUC) and odds ratios for mechanical ventilation (MV) and respiratory support (RS). Prolonged MV and RS were defined using ≥ 90th percentile of observed/expected ratios. Secondary outcomes were prolonged CICU and hospital length of stay (LOS) and kidney failure (stage III acute kidney injury (AKI), peritoneal dialysis, and/or continuous kidney replacement therapy on postoperative day three) assessed using covariate-adjusted ROC-AUC curves. Results: A total of 782 children were included. Cumulative urine output (UOP) metrics were lower in prolonged MV and RS patients, but DR poorly predicted prolonged MV (highest AUC 0.611, OR 0.98, sensitivity 0.67, specificity 0.53, p = 0.006, 95% OR CI 0.96–0.99 for cumulative 6-h UOP) and RS (highest AUC 0.674, OR 0.94, sensitivity 0.75, specificity 0.54, p < 0.001, 95% CI 0.91–0.97 UOP between 3 and 6 h). Secondary outcome results were similar. DR had fair discrimination for kidney failure (AUC 0.703, OR 0.94, sensitivity 0.63, specificity 0.71, 95% OR CI 0.91–0.98, p < 0.001, cumulative 6-h UOP). Conclusions: Early DR poorly discriminated patients with prolonged MV, RS, and LOS in this cohort, though it may identify severe postoperative AKI phenotype. Future work is warranted to determine if early DR or late postoperative DR later, in combination with other AKI metrics, may identify a higher-risk phenotype. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|