İzole Koroner Arter Baypas Greftleme Cerrahisinde Preoperatif Hepatik Steatoz Postoperatif Akut Böbrek Hasarının Bir Öngördürücüsü müdür?

Öz

Amaç: Bu çalışmanın amacı, izole koroner arter baypas greftleme (KABG) uygulanan hastalarda preoperatif hepatik steatozun postoperatif akut böbrek hasarı (ABH) gelişimi üzerindeki prognostik etkisini değerlendirmektir. Yöntem: Bu retrospektif, tek merkezli kohort çalışmaya Ocak 2020 ile Aralık 2022 tarihleri arasında izole KABG uygulanan 146 hasta dahil edildi. Preoperatif hepatik steatoz, kontrastsız bilgisayarlı tomografi (BT) görüntüleri kullanılarak değerlendirildi ve karaciğer atenüasyon indeksi (LAI) kullanılarak kantitatif olarak ölçüldü. Hastalar LAI değerlerine göre hafif, orta ve şiddetli hepatik steatoz olmak üzere üç gruba ayrıldı. Bulgular: Çalışmaya dahil edilen hastaların %26’sında postoperatif ABH gelişti. Hepatik steatoz dağılımı şu şekilde belirlendi: hastaların %67,1’inde hafif, %21,09’unda orta ve %11,0’ında şiddetli hepatik steatoz. Çok değişkenli lojistik regresyon analizinde, şiddetli hepatik steatoz, yaş (OR: yıl başına 1,09; %95 GA: 1,02–1,14; p=0,008) ve diabetes mellitus (OR: 2,35; %95 GA: 1,11–4,95; p=0,025) postoperatif ABH’nin bağımsız öngördürücüleri olarak belirlendi. Şiddetli hepatik steatozun ABH gelişimi üzerindeki etkisinin güçlü düzeyde anlamlı olduğu bulundu (OR: 5,87; %95 GA: 1,83–18,85; p=0,003). Hiperlipidemi ABH riskinde artış gösterdi; ancak istatistiksel anlamlılığa ulaşmadı (OR: 2,49; %95 GA: 0,85–7,31; p=0,097). Değişkenler arasındaki ilişkinin analizi orta düzeyde bir ilişki gösterdi (Cramér’s V: 0,354). Sonuç: Preoperatif şiddetli hepatik steatozun, KABG cerrahisi uygulanan hastalarda postoperatif ABH’nin anlamlı ve bağımsız bir öngördürücüsü olduğu bulundu. Preoperatif dönemde hepatik steatozun değerlendirilmesi, yüksek riskli hasta gruplarının erken belirlenmesine katkı sağlayarak ABH riskini azaltmaya ve cerrahi sonuçları iyileştirmeye yönelik stratejilerin geliştirilmesinde klinik açıdan değerli olabilir. Anahtar Kelimeler: hepatik steatoz; akut böbrek hasarı; koroner arter baypas greftleme; hepatik atenüasyon indeksi; risk faktörleri

Anahtar Kelimeler

• hepatik steatoz
• akut böbrek hasarı
• koroner arter baypas greftleme
• hepatik atenüasyon indeksi
• risk faktörleri

Etik Beyan

The study was approved by Bursa Yuksek Ihtisas Training and Research Hospital Clinical Research Ethics Committee (Date: 15-06-2022, protocol number: 2011-KAEK-25 2022/06-22)

Preoperative Hepatic Steatosis as a Postoperative Acute Renal Damage Predictor in Isolated Coronary Artery Bypass Grafting Surgery?

Öz

Aim: The aim of this study was to evaluate the prognostic effect of preoperative hepatic steatosis on the development of postoperative acute kidney injury (AKI) in patients undergoing isolated coronary artery bypass grafting (CABG). Methods: This retrospective, single-center cohort study included 146 patients who underwent isolated CABG between January 2020 and December 2022. Preoperative hepatic steatosis was assessed using non-contrast computed tomography (CT) images and quantitatively measured using the liver attenuation index (LAI). Patients were divided into three groups based on LAI values: mild, moderate, and severe hepatic steatosis. Results: Postoperative AKI developed in 26% of the patients included in the study. The distribution of hepatic steatosis was determined as follows: mild in 67.1% of patients, moderate in 21.09% of patients, and severe hepatic steatosis in 11.0% of patients. In multivariate logistic regression analysis, severe hepatic steatosis, age (OR: 1.09 per year; 95% CI: 1.02–1.14; p=0.008), and diabetes mellitus (OR: 2.35; 95% CI: 1.11–4.95; p=0.025) were identified as independent predictors of postoperative AKI. The effect of severe hepatic steatosis on the development of AKI was found to be strongly significant (OR: 5.87; 95% CI: 1.83–18.85; p=0.003). Hyperlipidemia showed an increased risk of AKI but did not reach statistical significance (OR: 2.49; 95% CI: 0.85–7.31; p=0.097). Analysis of the relationship between the variables showed a moderate level of association (Cramér’s V: 0.354). Conclusion: Preoperative severe hepatic steatosis was found to be a significant and independent predictor of postoperative AKI in patients undergoing CABG surgery. Assessment of hepatic steatosis in the preoperative period may be clinically valuable in developing strategies to reduce the risk of AKI and improve surgical outcomes by contributing to the early identification of high-risk patient groups. Keywords: hepatic steatosis; acute renal failure; coronary artery bypass graft; hepatic attenuation ındex; risk factors

Anahtar Kelimeler

• hepatic steatosis
• acute renal failure
• coronary artery bypass graft
• hepatic attenuation ındex
• risk factors

Etik Beyan

The study was approved by Bursa Yuksek Ihtisas Training and Research Hospital Clinical Research Ethics Committee (Date: 15-06-2022, protocol number: 2011-KAEK-25 2022/06-22)

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