CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 4, September/October 2023 AFRICA 201 The intra-operative and postoperative data of the patients are shown in Table 3. Intubation time (p = 0.0001), stay in ICU (p = 0.0001) and length of hospital stay (p = 0.0001) were significantly different between the groups. Neurological event rate (transient ischaemic event, speech disorder, hemiplegia or hemiparesis) within the first 72 hours postoperatively was different between the groups [group 1; two (3.2%) patients, group 2; five (2.9%) patients; p = 0.60]. Likewise, in-hospital mortality following the first 72 postoperative hours occurred in one (1.6%) patient in group 1 and in two (1.1%) patients in group 2, which showed no statistical difference between the groups (p = 0.79). The results of univariate and multivariate regression analysis of patients who developed AKI in the early postoperative period are shown in Tables 4 and 5. In multivariate analysis, the variables that were found to be statistically significantly associated with postoperative AKI in univariate analysis were increased CIMT (p = 0.005), pre-operative CRP (p = 0.001), ESR (p = 0.005), NLR (p = 0.0001) and PLR (p = 0.0001); increased postoperative seventh-day CRP (p = 0.04), postoperative firstday PLR (p = 0.0001), postoperative seventh-day ESR (p= 0.02), and intubation time (p = 0.02). These were found to be independent predictors of early postoperative AKI. The result of the analyses showed not only that the regression model was significant [F (18, 218) = 57.09, p < 0.0001] but also that 81% (R2 adjusted = 0.81) of the variance of postoperative AKI, as the dependent variable, was expressed by the independent variables. The ROC curves for CIMT were in connection with postoperative AKI following isolated CABG (Fig. 1). The area Table 3. Intra-operative and postoperative data of the patients Characteristics Group I AKI (n = 63) Group II non-AKI (n = 174) p-value Median (min–max) Median (min–max) Aortic cross-clamping time (min) 54.5 (20–78) 56.1 (21–82) 0.81** Cardiopulmonary bypass time (min) 85.5 (46–114) 86.5 (42–117) 0.68** Number of distal anastomoses 3.22 (1–5) 3.30 (1–5) 0.64** Amount of drainage (ml) 314 (200–1150) 317 (150–1200) 0.43* Intubation time (h) 6.5 (4–12) 5.5 (3–11) 0.0001** Stay in the ICU (h) 38.9 (18–96) 20.8 (17–87) 0.0001** Total duration of hospital stay (days) 8.3 (5–16) 5.6 (5–11) 0.0001** Use of inotropic support, n (%) 4 (6.3 16 (9.2%) 0.49* Use of blood products, n (%) 29 (46.0) 74 (42.5) 0.63* *Pearson’s chi-squared test or Fisher’s exact test; **Mann–Whitney U-test. Table 4. Univariate and multivariate regression analysis of patient’s characteristics and pre-operative risk factors for postoperative AKI Variables Postoperative AKI Unadjusted OR (95% CI) p-value R2 Adjusted OR (95% CI) p-value Gender 1.36 (0.71–2.60) 0.36 – – Age 1.03 (0.99–1.07) 0.11 – – Ejection fraction (%) 1.01 (0.97–1.04) 0.87 – – Diabetes mellitus 0.90 (0.49–1.64) 0.73 – – Hypertension 1.03 (0.56–1.89) 0.93 – – Hyperlipidaemia 0.85 (0.47–1.52) 0.57 – – Smoking 1.60 (0.89–2.88) 0.12 – – BMI (kg/m2) 1.02 (0.94–1.10) 0.67 – – CIMT (mm) 2.27 (1.82–2.71) 0.0001 0.30 4.04 (1.23–6.85) 0.005 Pre-operative creatinine (mg/dl) 1.39 (0.48–4.02) 0.54 – – Pre-operative urea (mg/dl) 0.99 (0.93–1.06) 0.91 – – Pre-operative uric acid (mg/dl) 1.18 (0.94–1.46) 0.15 – – Pre-operative LDL-C (mg/dl) 0.99 (0.97–1.01) 0.54 – – Pre-operative CRP (mg/l) 3.24 (2.79–3.70) 0.0001 0.46 6.90 (2.70–11.10) 0.001 Pre-operative PLR 2.00 (1.60–2.40) 0.0001 0.32 2.27 (1.14–3.40) 0.0001 Pre-operative NLR 2.66 (2.26–3.06) 0.0001 0.43 3.22 (1.46–4.98) 0.0001 Pre-operative haemoglobin (mg/dl) 0.92 (0.77–1.11) 0.39 – – Pre-operative haematocrit (%) 0.97 (0.90–1.04) 0.41 – – Pre-operative leucocyte (× 103 cells/µl) 0.99 (0.98–1.00) 0.44 – – Pre-operative HbA1c (%) 1.17 (0.97–1.41) 0.11 – – Pre-operative eGFR (ml/min/1.73 m2) 1.00 (0.98–1.02) 0.82 – – Pre-operative ESR (mm/h) 1.31 (1.20–1.42) 0.0001 0.19 1.13 (0.87–1.45) 0.005 CRP: C-reactive protein; LDL-C: low-density lipoprotein cholesterol; ESR: erythrocyte sedimentation rate; PLR: platelet-to-lymphocyte ratio; NLR: neutrophil-to-lymphocyte ratio; BMI: body mass index; eGFR: estimated glomerular filtration rate; HbA1c: glycosylated haemoglobin. Table 5. Univariate and multivariate regression analysis of operative and early postoperative risk factors for postoperative AKI Variables Postoperative AKI Unadjusted OR (95% CI) p-value R2 Adjusted OR (95% CI) p-value Haemoglobin post- operative day 1 0.95 (0.74–1.23) 0.72 – – Haematocrit post- operative day 1 0.99 (0.90–1.09) 0.88 – – Uric acid postoperative day 1 0.97 (0.79–1.20) 0.79 – – CRP postoperative day 1 1.20 (1.13–1.27) 0.0001 0.17 0.89 (0.69–1.15) 0.47 CRP postoperative day 3 1.22 (1.16–1.28) 0.0001 0.46 1.18 (1.00–1.38) 0.11 CRP postoperative day 7 1.34 (1.24–1.45) 0.0001 0.38 1.11 (0.84–1.48) 0.04 PLR postoperative day 1 1.10 (0.90–1.30) 0.0001 0.34 2.03 (1.34–2.72) 0.0001 PLR postoperative day 3 1.21 (0.95–1.47) 0.0001 0.29 0.98 (0.94–1.02) 0.06 PLR postoperative day 7 0.70 (0.40–1.00) 0.0001 0.12 0.97 (0.93–1.01) 0.30 NLR postoperative day 1 1.52 (1.17–1.87) 0.0001 0.24 1.12 (0.84–1.40) 0.25 NLR postoperative day 3 1.06 (0.67–1.44) 0.0001 0.11 0.92 (0.86–0.98) 0.77 NLR postoperative day 7 1.35 (0.97–1.73) 0.0001 0.17 0.96 (0.92–1.00) 0.29 ESR postoperative day 1 1.08 (1.05–1.11) 0.0001 0.14 0.96 (0.83–1.11) 0.53 ESR postoperative day 3 1.16 (1.11–1.20 0.0001 0.39 1.16 (0.95–1.41) 0.17 ESR postoperative day 7 1.19 (1.13–1.25) 0.0001 0.25 1.21 (0.99–1.49) 0.02 Aortic cross-clamping time 1.00 (0.98–1.02) 0.90 – – Number of distal anastomoses 0.96 (0.72–1.27) 0.77 – – CPB time 1.00 (0.98–1.02) 0.87 – – Intubation time 1.53 (1.25–1.86) 0.0001 0.09 3.63 (1.22–10.82) 0.02 Use of blood products 1.15 (0.65–2.06) 0.63 – – Use of inotropic support 0.72 (0.23–2.25) 0.57 – – Amount of drainage 1.00 (0.99–1.01) 0.51 – – CRP: C-reactive protein; CPB: cardiopulmonary bypass; ESR: erythrocyte sedimentation rate; NLR: neutrophil-to-lymphocyte ratio; PLR: platelet-to-lymphocyte ratio.
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