RESUMO
La insuficiencia renal aguda (IRA) es una complicación asociada a la cirugía cardíaca con circulación extracorpórea (CEC) con impacto en la morbimortalidad. OBJETIVO: Identificar los factores de riesgo asociados a IRA posquirúrgica de acuerdo a la escala pRIFLE (pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease) en niños intervenidos de cirugía cardiaca con CEC. PACIENTES Y MÉTODO: Se realizó un estudio de casos y controles anidados en una cohorte. Se incluyó a pacientes menores a 16 años de edad que ingresaron en una unidad de terapia intensiva pediátrica posterior a cirugía cardiaca con CEC en un período de 18 meses. Los casos fueron quienes desarrollaron IRA de acuerdo a la clasificación pRIFLE durante su estancia en la unidad de terapia intensiva. Los controles fueron aquellos que no desarrollaron esta complicación. Se realizó un análisis de regresión logística y se calcularon odds ratio (OR) e intervalos de confianza al 95% (IC 95%). RESULTADOS: Se estudiaron 91 pacientes (31 casos y 60 controles) con una mediana de edad de 20 meses y predominio del sexo masculino (53,8%). Los factores de riesgo independientes para IRA fueron la hiperlactatemia transoperatoria > 6 mmol/l (OR = 4,91; IC 95%:1,26-19,05; p = 0,02) y las cardiopatías cianógenas (OR = 3,62; IC 95%:1,11-11,63; p = 0,03). CONCLUSIONES: Este estudio permitió identificar que los pacientes pediátricos con niveles de lactato > 6 mmol/l durante la CEC y aquellos con cardiopatías congénitas cianógenas son un subgrupo de alto riesgo para desarrollar IRA tras cirugía cardiaca y deben vigilarse estrechamente para prevenir, detectar y/o tratar de forma oportuna dicha complicación.
Acute renal failure (ARF) is a complication associated with cardiac surgery with cardiopulmonary bypass (CPB) with an impact on morbidity and mortality. OBJECTIVE: To identify risk factors associated with postoperative IRA according to pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease scale in children undergoing cardiac surgery with CPB. PATIENTS AND METHOD: A nested case-control study was conducted. We included children under 16 years of age attended postoperative for CBP in a pediatric intensive care unit over a period of 18 months. The cases were those who developed ARF according to the classification pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease scale during their stay in the pediatric intensive care unit. Controls were those who did not develop this complication. Logistic regression analysis was performed and adjusted odds ratio (OR) and confidence intervals at 95% (95% CI) were calculated. RESULTS: 91 patients (31 cases and 60 controls) with a median age of 20 months and predominance of males (53.8%) were analyzed. Independent risk factors for ARF were the intraoperative lactate level > 6 mmol/l (OR = 4.91; 95% CI 1.26-19.05; p = .02) and cyanotic heart disease (OR = 3.62; 95% CI 1.11-11.63; p = .03). CONCLUSIONS: This study identified that pediatric patients with lactate levels >6 mmol/l during CPB and those with cyanotic congenital heart disease are a subgroup of high risk to develop ARF after heart surgery and should be closely monitored to prevent, detect and/or treat this complication timely manner.