Acute kidney injury is a common postoperative complication of paediatric cardiac surgery associated with increased morbidity and mortality. The purpose of this study is to characterise associations between haemodynamic parameters, clinical parameters, and medical interventions, on acute kidney injury.

Nine patients with univentricular physiology undergoing the Norwood procedure from a single-centre tertiary care paediatric cardiac ICU were included (September 2022 to March 2023). Patients were monitored with the T3 software. Data were analysed using a Fisher exact test, Mann–Whitney-U test, LASSO-based machine learning techniques, and receiver operator curve analyses.

Over 27,000 datapoints were included. Acute kidney injury occurred in 2 patients (22%) during this period. Net fluid balance and renal oxygen extraction were independently associated with acute kidney injury, while commonly used metrics of pressure (systolic, diastolic, or mean arterial blood pressure) were not. The resulting acute kidney injury risk score was (4.1 × fluid balance) + (1.9 × renal oxygen extraction). The risk score was significantly higher in acute kidney injury with a score of 32.9 compared to 7.9 (p < 0.01). Optimal cut-offs for fluid balance (7 mL/hr) and renal oxygen extraction (29%) were identified. Higher serum creatinine:baseline creatinine ratio was associated with a higher mean airway pressure, higher renal oxygen extraction, higher mean arterial blood pressure, higher vasoactive inotropic score, and fluid balance.

Among patients with univentricular physiology undergoing the Norwood procedure, renal oxygen extraction and a higher net fluid balance are independently associated with increased risk of acute kidney injury. Renal perfusion pressure is not significantly associated with acute kidney injury.

急性肾损伤是小儿心脏手术常见的术后并发症，与发病率和死亡率增加相关。本研究的目的是表征急性肾损伤的血流动力学参数、临床参数和医疗干预之间的关联。

研究纳入了来自单中心三级护理儿科心脏 ICU 的 9 名单心室生理学患者（2022 年 9 月至 2023 年 3 月）接受诺伍德手术。使用 T3 软件对患者进行监测。使用 Fisher 精确检验、Mann–Whitney- U检验、基于 LASSO 的机器学习技术和受试者操作曲线分析来分析数据。

其中包含超过 27,000 个数据点。在此期间有2例患者（22%）发生急性肾损伤。净液体平衡和肾氧摄取量与急性肾损伤独立相关，而常用的压力指标（收缩压、舒张压或平均动脉压）则不然。由此产生的急性肾损伤风险评分为（4.1 × 液体平衡）+（1.9 × 肾吸氧量）。急性肾损伤的风险评分显着较高，为 32.9 分，而急性肾损伤的风险评分为 7.9 分 ( p < 0.01)。确定了液体平衡（7 mL/hr）和肾氧提取（29%）的最佳截止值。较高的血清肌酐：基线肌酐比值与较高的平均气道压力、较高的肾吸氧量、较高的平均动脉血压、较高的血管活性正性肌力评分和液体平衡相关。

在接受诺伍德手术的单心室生理学患者中，肾吸氧量和较高的净液体平衡与急性肾损伤风险增加独立相关。肾灌注压与急性肾损伤没有显着相关性。