Platelet Counts Linked to AKI Severity in Pediatric Open-Heart Surgery

(HealthDay News) — For pediatric patients undergoing cardiopulmonary bypass (CPB), postoperative nadir platelet counts are associated with the severity of acute kidney injury (AKI), according to a review published online in Pediatric Anesthesia.

Shannon Tew, MD, from Camelback Anesthesiology Consultants in Tempe, Ariz, and colleagues conducted a retrospective review of medical records and database for a single institution over a 5-year period for 814 patients younger than 21 years undergoing cardiac surgery with CPB. They captured demographics, laboratory, and surgical characteristics, and recorded clinical event rates.

The researchers observed a 48% decrease in postoperative platelet counts from baseline, reaching a mean nadir value of 150 × 10⁹ L⁻¹ on postoperative day three. 37% of patients had AKI, including 13%, 17%, and 6%, respectively, with Acute Kidney Injury Network stages 1, 2, and 3. There was a correlation for the magnitude of nadir platelet counts and the severity of AKI. Nadir platelet counts, CPB time, Aristotle score, patient weight, intraoperative packed red blood cell transfusion, and having a heart transplant procedure were independent predictors of AKI severity.

“In pediatric open-heart surgery, thrombocytopenia and AKI occur commonly following CPB,” the authors write. “Our findings show a strong association between nadir platelet counts and the severity of AKI.”

Reference

1. Tew S, Fontes ML, Greene NH, et al. Natural history of nonimmune-mediated thrombocytopenia and acute kidney injury in pediatric open-heart surgery. Paediatr Anaesth. 18 January 2017. doi: 10.1111/pan.13063. [Epub ahead of print]