Association between end of surgery cerebral tissue oxygen saturation as measured by cerebral near-infrared spectroscopy and the incidence of acute kidney injury after cardiac surgery.

Details

Supervisors

Christine Ray

Faculty

Faculté de pharmacie et des sciences biomédicales

Degree label

Master [120] en sciences biomédicales, à finalité spécialisée: sciences biomédicales cliniques

Abstract

Acute kidney injury (AKI) is linked to multiple morbidities and an increased mortality rate. It is a common cardiac surgery-related complication. Early diagnosis could limit the progression of AKI, but current screening techniques are still limiting. However, new studies are focusing on the application of near-infrared spectroscopy (NIRS). The device is connected to electrodes that are placed on the skin to measure the regional oxygen saturation (rSO2). This study investigates an association between NIRS measurements of the brain’s regional oxygen saturation at the end of cardiac surgery and the onset of cardiac surgery-related acute kidney injury (CSR-AKI). The data for this retrospective study was taken from 2020 patients undergoing cardiac surgery at the Cliniques Universitaires Saint-Luc between 2006 and 2019. Following the criteria of the Acute Kidney Injury Network (AKIN) classification, 10.6% (210) of the patients were classified as having developed CSR-AKI. Multiple variables were compared, including mean preoperative and postoperative cerebral rSO2, the most determining variable in this study. In addition, a second study was carried out among patients who presented cerebral desaturation during the operation of at least 20%. Lastly, a multivariate analysis was performed to look at the effect of the measurements taken by NIRS in a more comprehensive model. The cerebral rSO2 (rScO2) of 2020 patients was measured throughout cardiac surgery using an INVOSTM cerebral NIRS. The average postoperative cerebral rSO2 was associated with a lower measure in patients who developed CSR-AKI than in patients who did not. The other variables also showed a significant odds ratio except for sex, body mass index (BMI), maximum area under the curve (AUC) and maximum suppression ratio (SR). Comparable results were observed in the group of patients with cerebral desaturation during the operation of at least 20%. In the multivariate analysis, the postoperative rScO2 taken by NIRS was significant. Measurements of rScO2 by the NIRS at the end of cardiac surgery have the potential to help physicians predict the onset of CSR-AKI. However, its exact relationship between regional cerebral oxygen saturation and the occurrence of AKI requires further studies.