Abstract
Background
Proteinuria is a non-specific marker of inflammation that may reflect the glomerular component of systemic capillary leak. The objective of this pilot study was to determine if postoperative proteinuria is associated with adverse outcomes following cardiac surgery with cardiopulmonary bypass.
Methods
Eligible patients were individuals undergoing cardiac surgery with cardiopulmonary bypass who did not have severe pre-existing renal dysfunction. Urine was collected after induction of anesthesia (baseline) and two to four hours after arrival to the intensive care unit (ICU). Proteinuria was measured as random protein creatinine ratio in g·mol-1. Adverse events were defineda priori as prolonged ICU stay (≥ 90th percentile) and organ dysfunction. The relationship between proteinuria and adverse events was assessed by bivariate (Chi-square or Fisher’s exact tests) and multivariable (multiple logistic regression) analyses.
Results
The study included 197 (of 243 eligible) patients. Postoperative proteinuria (protein creatinine ratio ≥ 30 g·mol-1) was associated with prolonged (≥ four days) ICU stay [odds ratio (OR) 7.0; 95% confidence interval (CI) 2.8-17.1] and organ dysfunction (OR 3.9; CI 1.9-8.1). After adjustment for confounders, proteinuria was associated with a 3.2-fold increase in the odds of both prolonged ICU stay (CI 1.1-9.7) and organ dysfunction (CI 1.4-7.0).
Conclusions
Proteinuria two to four hours after cardiac surgery with cardiopulmonary bypass may be a useful marker for systemic capillary leak and adverse postoperative events. Large prospective studies are needed to confirm these findings. Objectif : La protéinurie est un marqueur non spécifique de ľinflammation qui peut illustrer la composante glomérulaire ďune fuite capillaire systémique. Nous voulions déterminer si la protéinurie postopératoire est associée à des complications de la chirurgie cardiaque avec circulation extracorporelle.
Résumé
Méthode
Les patients admissibles devaient subir une opération cardiaque avec circulation extracorporelle, mais ne devaient pas présenter de dysfonction rénale sévère préexistante. Ľurine a été recueillie après ľinduction de ľanesthésie (conditions de départ) et entre deux et quatre heures après ľarrivée à ľunité des soins intensifs (USI). La protéinurie a été mesurée comme le ratio aléatoire protéine-créatinine en g·mol-1. Les événements indésirables ont été définis a priori : un séjour prolongé à ľUSI (≥ 90e percentile) et une dysfonction organique. La relation entre la protéinurie et les événements indésirables a été évaluée par des analyses bivariée (chi carré et tests exacts de Fisher) et multivariée (régression logistique multiple).
Résultats
Ľétude a porté sur 197 des 243 patients admissibles. La protéinurie postopératoire (ratio protéine créatinine ≥ 30 g·mol-1) a été associée à un séjour prolongé (≥ quatre jours) à ľUSI [risque relatif (RR) 7,0 ; intervalle de confiance de 95 % (IC) 2,8-17,1] et à une dysfonction organique (RR 3,9; IC 1,9-8,1). Après ajustements pour les facteurs de confusion, la protéinurie a été associée à 3,2 fois ďaugmentation des risques relatifs du séjour prolongé à ľUSI (IC 1,1-9,7) et de la dysfonction organique (IC 1,4-7,0).
Conclusion
La protéinurie mesurée deux à quatre heures après une intervention en chirurgie cardiaque avec circulation extracorporelle peut être un marqueur indiquant une fuite capillaire systémique et des événements postopératoires indésirables. Ces résultats devront être confirmés dans de grandes études prospectives.
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Karkouti, K., Shayan, S., Wijeysundera, D.N. et al. Prognostic value of postoperative proteinuria in cardiac surgery: a pilot study. Can J Anesth 53, 500–506 (2006). https://doi.org/10.1007/BF03022624
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DOI: https://doi.org/10.1007/BF03022624