Effect Of Preoperative High-density Lipoprotein On Acute Kidney Injury After Cardiac Valve Replacement Surgery

Objective:Cardiac surgery associated acute kidney injury（CSA-AKI）is a common complication after cardiac surgery especially cardiopulmonary bypass surgery.It not only adversely affects the prognosis and quality of life of patients,but also increases the postoperative mortality and the economic burden on patients.We aimed to explore the relationship between preoperative high-density lipoprotein（HDL）and acute kidney injury（AKI）after cardiac valve replacement surgery.Methods:Medical records of adult patients who were admitted to the cardiac surgery department and underwent cardiac valve replacement during January 1,2020 to October 1,2021 in the anesthesia management system of The First Bethune Hospital of Jilin University were searched and eligible cases were selected.Clinical records of patients include: name,age,gender,previous medical history/comorbidities（hypertension,diabetes,chronic obstructive pulmonary disease,peripheral vascular disease,history of cardiac surgery,obesity,anemia,hypoalbuminemia,hyperuricemia）,cardiopulmonary bypass time,aorta blocking time,intraoperative blood transfusion,preoperative and postoperative creatinine values,preoperative HDL levels,preoperative left ventricular ejection fractions（LVEF）,preoperative New York Heart Association classification（NYHA）,length of stay,and in-hospital deaths.We used the Kidney Disease: Improving Global Outcomes（KDIGO）criteria to diagnose AKI and divided patients into the AKI group and the non-AKI group.We evaluated the effect of preoperative HDL on postoperative AKI and identified risk factors for AKI after cardiac valve replacement by univariate analysis and multivariate Logistic regression analysis.Results:A total of 227 patients were included in this study,58 patients（25.6%）developed postoperative AKI,169 patients（74.4%）did not develop postoperative AKI,and 5 patients（2.2%）died in hospital.Statistical comparison between the AKI group and the non-AKI group showed that patients of the AKI group were older,longer hospital stay,and higher inhospital mortality with significant differences（P<0.05）.The results of regression analysis showed that after adjustment for age,hypertension,diabetes,history of cardiac surgery,obesity,anemia,hypoalbuminemia,hyperuricemia,LVEF value,NYHA class Ⅲ-Ⅳ,preoperative creatinine value,intraoperative blood transfusion,cardiopulmonary bypass time>120minutes and aortic occlusion time,preoperative higher HDL level was still an independent protective factor for AKI after heart valve replacement（OR=0.039,95%CI 0.002-0.646,P=0.023）.In addition,age（OR=1.062,95%CI 1.001-1.126,P=0.046）,hypertension（OR=2.849,95%CI 1.129-7.193,P=0.027）,diabetes（OR=2.990,95%CI 1.152-7.759,P=0.024）,history of cardiac surgery（OR=4.587,95%CI 1.158-18.178,P=0.03）,NYHA class Ⅲ-Ⅳ（OR=2.767,95%CI 1.064-7.200,P=0.037）,preoperative creatinine level（OR=1.044,95%CI 1.018-1.070,P=0.001）,cardiopulmonary bypass time > 120 minutes（OR=2.827,95%CI 1.050-7.614,P=0.04）,aortic occlusion time（OR=1.023,95%CI 1.004-1.041,P=0.017）were risk factors for AKI after heart valve replacement,and higher preoperative LVEF（OR=0.911,95%CI 0.846-0.981,P=0.014）was considered to be a protective factor.Conclusions:Higher preoperative HDL level and higher preoperative LVEF were independent protective factors for AKI after heart valve replacement.Age,high blood pressure,diabetes,heart surgery history,NYHA class Ⅲ-Ⅳ,preoperative creatinine value,cardiopulmonary bypass time>120minutes and aortic occlusion time are independent risk factors for AKI after heart valve replacement.