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Fluid Overload and AKI After the Norwood Operation: The Correlation and Characterization of Routine Clinical Markers

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Abstract

The purpose of this study was to determine the correlation of different methods of assessing fluid overload and determine which metrics are associated with development of acute kidney injury (AKI) in the period immediately following Norwood palliation. This was a retrospective single-center study of Norwood patients from January 2011 through January 2021. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO). Patients were separated into two groups: those with AKI and those without. A logistic regression analysis was conducted with AKI at any point in the study period as the dependent variable and clinical and laboratory data as independent variables. Analysis was conducted as a stepwise regression. The coefficients from the logistic regression were then used to develop a cumulative AKI risk score. Spearman correlations were conducted to analyze the correlation of fluid markers. 116 patients were included, and 49 (42.4%) developed AKI. The duration of open chest, duration of mechanical ventilation, need for dialysis, need for extracorporeal membrane oxygenation, and inpatient mortality were associated with AKI (p ≤ 0.05). Stepwise logistic regression demonstrated the following significant independent associations AKI: age at Norwood in days (p < 0.01), blood urea nitrogen (p < 0.01), central venous pressure (p = 0.04), and renal oxygen extraction ratio (p < 0.01). The area under the receiver operating characteristic curve for the logistic regression was 0.74. The fluid markers had weak R-value. Urea, central venous pressure, and renal oxygen extraction ratio are associated with AKI after the Norwood operation. Common clinical metrics used to assess fluid overload are poorly correlated with each other for postoperative Norwood patients.

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Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, Advocate Children’s Hospital, Oak Lawn, IL, USA

    Julia Weld & Rohit S. Loomba

  2. Division of Nephrology, Department of Pediatrics, Advocate Children’s Hospital, Oak Lawn, IL, USA

    Erin Kim & Priya Chandra

  3. Division of Critical Care and Cardiology, Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, USA

    Fabio Savorgnan, Sebastian Acosta & Saul Flores

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  1. Julia Weld
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Contributions

RL and JW were responsible for study design. JW performed data collection. RL performed data analysis and prepared figures and tables. JW and RL wrote the main manuscript text. All authors reviewed the manuscript.

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Correspondence to Julia Weld.

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Weld, J., Kim, E., Chandra, P. et al. Fluid Overload and AKI After the Norwood Operation: The Correlation and Characterization of Routine Clinical Markers. Pediatr Cardiol (2023). https://doi.org/10.1007/s00246-023-03167-0

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