title: Natural history of nonimmune-mediated thrombocytopenia and acute kidney injury in pediatric open-heart surgery.
abstract: OBJECTIVE
  Thrombocytopenia and acute kidney injury (AKI) are common following pediatric cardiac surgery with cardiopulmonary bypass (CPB). However, the relationship between postoperative nadir platelet counts and AKI has not been investigated in the pediatric population. Our objective was to investigate this relationship and examine independent predictors of AKI.
  
  
  METHODS
  After IRB approval, we performed a retrospective review of the institution's medical records and database.
  
  
  METHODS
  This study was performed at a single institution over a 5-year period.
  
  
  METHODS
  We included patients <21 years of age undergoing cardiac surgery with CPB.
  
  
  METHODS
  Demographics, laboratory, and surgical characteristics were captured, and clinical event rates were recorded.
  
  
  METHODS
  Descriptive statistics were used to evaluate platelet and creatinine distributions. T-tests and chi-squared tests were used to compare characteristics among Acute Kidney Injury Network groups. Multivariable logistic and ordinal logistic regression models were used to determine the association of our predictor of interest, postoperative nadir platelet count and AKI.
  
  
  RESULTS
  Eight hundred and fourteen patients (23% infants and 23% neonates) were included in the analysis. Postoperative platelet counts decreased 48% from baseline reaching a mean nadir value of 150 × 109·l-1on postoperative day 3. AKI occurred in 37% of patients including 13%, 17%, and 6% with Acute Kidney Injury Network stages 1, 2, and 3, respectively. The magnitude of nadir platelet counts correlated with the severity of AKI. Independent predictors of severity of AKI include nadir platelet counts, CPB time, Aristotle score, patient weight, intra-operative packed red blood cell transfusion, and having a heart transplant procedure.
  
  
  CONCLUSIONS
  In pediatric open-heart surgery, thrombocytopenia and AKI occur commonly following CPB. Our findings show a strong association between nadir platelet counts and the severity of AKI.
authors.affiliation: Camelback Anesthesiology Consultants, Tempe, AZ, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Tew
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Manuel L
authors.initials: ML
authors.lastname: Fontes
authors.affiliation: Pediatric Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Nathaniel H
authors.initials: NH
authors.lastname: Greene
authors.affiliation: Pediatric Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Miklos D
authors.initials: MD
authors.lastname: Kertai
authors.affiliation: Division of Critical Care, Department of Pediatrics, The Children's Hospital at Montefiore, Bronx, NY, USA.
authors.forename: George
authors.initials: G
authors.lastname: Ofori-Amanfo
authors.affiliation: Division of Congenital Cardiac Surgery, Department of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Robert D B
authors.initials: RD
authors.lastname: Jaquiss
authors.affiliation: Division of Congenital Cardiac Surgery, Department of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lodge
authors.affiliation: Pediatric Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Warwick A
authors.initials: WA
authors.lastname: Ames
authors.affiliation: Pediatric Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Hercilia Mayumi
authors.initials: HM
authors.lastname: Homi
authors.affiliation: Pediatric Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Machovec
authors.affiliation: Pediatric Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Edmund H
authors.initials: EH
authors.lastname: Jooste
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000150:complications*; D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010976:Platelet Count; D011183:Postoperative Complications / Q000097:blood*; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000097:blood* / Q000150:complications*; D055815:Young Adult
chemical_list: D003404:Creatinine
keywords: acute kidney injury; cardiopulmonary bypass; congenital cardiac disease; pediatrics; thrombocytopenia; thrombosis