Background: Considerable morbidity and death are associated with acute kidney damage (AKI) following total aortic arch replacement (TAAR). The relationship between AKI following TAAR and serum magnesium levels remains unknown. The intention of this research was to access the predictive value of serum magnesium levels on admission to the Cardiovascular Surgical Intensive Care Unit (CSICU) for AKI in patients receiving TAAR.
Methods: From May 2018 to January 2020, a prospective, observational study was performed in the Guangdong Provincial People's Hospital CSICU. Patients accepting TAAR admitted to the CSICU were studied. The Kidney Disease: Improving Global Outcomes (KDIGO) definition of serum creatinine was used to define AKI, and KDIGO stages two or three were used to characterize severe AKI. Multivariable logistic regression and area under the curve receiver-operator characteristic curve (AUC-ROC) analysis were conducted to assess the predictive capability of the serum magnesium for AKI detection. Finally, the prediction model for AKI was established and internally validated.
Results: Of the 396 enrolled patients, AKI occurred in 315 (79.5%) patients, including 154 (38.8%) patients with severe AKI. Serum magnesium levels were independently related to the postoperative AKI and severe AKI (both, P < 0.001), and AUC-ROCs for predicting AKI and severe AKI were 0.707 and 0.695, respectively. Across increasing quartiles of serum magnesium, the multivariable-adjusted odds ratios (95% confidence intervals) of postoperative AKI were 1.00 (reference), 1.04 (0.50-2.82), 1.20 (0.56-2.56), and 6.19 (2.02-23.91) (P for Trend < 0.001). When serum magnesium was included to a baseline model with established risk factors, AUC-ROC (0.833 vs 0.808, P = 0.050), reclassification (P < 0.001), and discrimination (P = 0.002) were further improved.
Conclusions: Serum magnesium levels on admission are an independent predictor of AKI. In TAAR patients, elevated serum magnesium levels were linked to an increased risk of AKI. In addition, the established risk factor model for AKI can be considerably improved by the addition of serum magnesium in TAAR patients hospitalized in the CSICU.
Uvod: Značajan morbiditet i smrt su povezani sa akutnim oštećenjem bubrega (AKI) nakon totalne zamene aortnog luka (TAAR). Veza između AKI nakon TAAR-a i nivoa magnezijuma u serumu ostaje nepoznata. Namera ovog istraživanja bila je da se pristupi prediktivnoj vrednosti nivoa magnezijuma u serumu pri prijemu u Jedinicu intenzivne kardiovaskularne hirurgije (CSICU) za AKI kod pacijenata koji primaju TAAR.
Metode: Od maja 2018. do januara 2020. sprovedena je prospektivna opservaciona studija u narodnoj bolnici provincije Guangdong CSICU. Proučavani su pacijenti koji prihvataju TAAR primljeni u CSICU. Bolest bubrega: poboljšanje globalnih ishoda (KDIGO) definicija serumskog kreatinina je korišćena za definisanje AKI, a KDIGO faze dva ili tri su korišćene za karakterizaciju teške AKI. Analiza multivarijabilne logističke regresije i površine ispod krive karakteristične krive prijemnik-operater (AUC-ROC) je sprovedena da bi se procenila prediktivna sposobnost serumskog magnezijuma za detekciju AKI. Konačno, model predviđanja za AKI je uspostavljen i interno potvrđen.
Rezultati: Od 396 uključenih pacijenata, AKI se javio kod 315 (79,5%) pacijenata, uključujući 154 (38,8%) pacijenata sa teškim AKI. Nivoi magnezijuma u serumu su bili nezavisno povezani sa postoperativnim AKI i teškim AKI (oba, P < 0,001), a AUC-ROC za predviđanje AKI i teškog AKI su bili 0,707 odnosno 0,695. U rastućim kvartilima serumskog magnezijuma, multivarijabilno prilagođeni odnosi šansi (95% intervala poverenja) postoperativnog AKI su bili 1,00 (referenca), 1,04 (0,50-2,82), 1,20 (0,56-2,56) i 6,19-232. P za Trend < 0,001). Kada je magnezijum u serumu uključen u osnovni model sa utvrđenim faktorima rizika, AUC-ROC (0,833 prema 0,808, P = 0,050), reklasifikacija (P < 0,001) i diskriminacija (P = 0,002) su dodatno poboljšani.
Zaključak: Nivoi magnezijuma u serumu pri prijemu su nezavisni prediktor AKI. Kod pacijenata sa TAAR, povišeni nivoi magnezijuma u serumu bili su povezani sa povećanim rizikom od AKI. Pored toga, uspostavljeni model faktora rizika za AKI može se značajno poboljšati dodatkom serumskog magnezijuma kod pacijenata sa TAAR hospitalizovanim u CSICU.
Keywords: acute aortic dissection; acute kidney injury; cardiovascular surgical intensive care unit; serum magnesium; total aortic arch replacement.
2024 Xinyi Jiang, Ziyun Li, Chixing Pan, Heng Fang, Wang Xu, Zeling Chen, Junjiang Zhu, Linling He, Miaoxian Fang, Chunbo Chen, published by CEON/CEES.