CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 5, November/December 2023 AFRICA 281 7) were stage III AKI. Renal failure requiring dialysis developed in three patients with stage III AKI. Mortality in the first postoperative month occurred in six patients (3.7%) in group 1 and in seven patients (0.9%) in group 2. The difference between the groups was statistically highly significant (p = 0.005). The results of univariate and multivariate regression analysis of patients who developed AKI in the early postoperative period are shown in Tables 5 and 6. In the multivariate analysis, the variables that were found to be statistically significantly associated with postoperative AKI in univariate analysis, were increased pre-operative monocyte counts (p = 0.0001), MHR (p = 0.0001) and pre-operative ESR levels (p = 0.001); increased postoperative first-day CRP levels (p = 0.0001), postoperative first- and third-day ESR levels (p = 0.002, p = 0.004, respectively) and MPV levels (p = 0.02, p = 0.0001, respectively). These were found to be independent predictors of early postoperative AKI. Table 5. Univariate and multivariate regression analysis of pre-operative risk factors for postoperative acute kidney injury Risk factors Postoperative AKI Unadjusted OR (95% CI) p R2 square Adjusted OR (95% CI) p Haemoglobin 1.07 (0.95–1.20) 0.26 – – – Creatinine 0.92 (0.51–1.66) 0.77 – – – Urea 1.02 (0.96–1.05) 0.78 – – – HbA1c 0.97 (0.86–1.09) 0.58 – – – eGFR 0.96 (0.92–1.00) 0.34 – – – Leucocyte count 0.91 (0.87–0.95) 0.79 – – – Thrombocyte count 0.99 (0.96–1.02) 0.41 – – – Monocyte count 1.20 (1.12–1.28) 0.0001 0.21 1.39 (0.96–2.01) 0.0001 CRP 1.90 (1.47–2.45) 0.0001 0.29 1.26 (0.82–1.95) 0.29 ESR 1.12 (1.07–1.16) 0.0001 0.30 1.11 (1.05–1.17) 0.0001 MPV 1.13 (1.35–1.96) 0.0001 0.17 1.12 (0.85–1.48) 0.43 HDL-C 1.01 (0.98–1.04) 0.75 – – – LDL-C 0.99 (0.97–1.01) 0.50 – – – Total cholesterol 0.99 (0.98–1.00) 0.36 – – – Triglycerides 1.00 (0.99–1.01) 0.74 – – – MHR 25.77 (22.37–29.17) 0.0001 0.19 21.57 (13.09–34.54) 0.0001 AKI, acute kidney injury; HDL-C, high-density lipoprotein cholesterol; eGFR, estimated glomerular filtration rate; LDL-C, low-density lipoprotein cholesterol; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; HbA1c, glycated haemoglobin; MPV, mean platelet volume; MHR, monocyte-to-high-density lipoprotein cholesterol ratio. Sensitivity 1 – Specificity 0.0 0.2 0.4 0.6 0.8 1.0 1.0 0.8 0.6 0.4 0.2 0.0 Fig. 1. ROC curve analysis of monocyte count-high-density lipoprotein ratio to predict postoperative AKI. Table 6. Univariate and multivariate regression analysis of peri-operative and postoperative risk factors for postoperative acute kidney injury. Risk factors Postoperative AKI Unadjusted OR (95% CI) p-value R2 Adjusted OR (95% CI) p-value Postoperative first-day haemoglobin 1.11 (0.96–1.29) 0.17 – – – Postoperative third-day haemoglobin 1.04 (0.98–1.10) 0.16 – – – Postoperative first-day leukocytes 0.97 (0.91–1.03) 0.24 – – – Postoperative third-day leukocytes 0.94 (0.89–0.99) 0.32 – – – Postoperative first-day CRP 1.12 (1.09–1.15) 0.0001 0.13 1.08 (1.05–1.11) 0.0001 Postoperative third-day CRP 1.09 (1.05–1.13) 0.0001 0.09 1.05 (0.99–1.11) 0.08 Postoperative first-day ESR 1.03 (1.01–1.05) 0.0001 0.10 1.02 (1.01–1.03) 0.002 Postoperative third-day ESR 1.05 (1.02–1.08) 0.0001 0.12 1.04 (1.01–1.07) 0.004 Postoperative first-day MPV 2.03 (1.67–2.46) 0.0001 0.16 1.45 (1.07–1.96) 0.02 Postoperative third-day MPV 1.99 (1.60–2.49) 0.0001 0.12 1.82 (1.36–2.44) 0.0001 Aortic cross-clamp time 1.01 (0.99–1.03) 0.65 – – – Number of anastomoses 1.03 (0.87–1.22) 0.75 – – – CPB time 1.02 (0.99–1.05) 0.84 – – – Intubation time 1.07 (0.95–1.20) 0.25 – – – Use of blood products 0.90 (0.63–1.23) 0.54 – – – Use of inotropic support 0.82 (0.44–1.54) 0.53 – – – Amount of drainage 1.00 (0.99–1.01) 0.34 – – – CPB, cardiopulmonary bypass; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; AKI, acute kidney injury. Table 4. Intra-operative and postoperative data of the patients Characteristics Group I: AKI (n = 161) Mean ± SD Group II: non-AKI (n = 793) Mean ± SD p-value Aortic cross-clamp time (min) 52.9 ± 12.9 52.3 ± 13.5 0.65* Cardiopulmonary bypass time (min) 83.4 ± 16.1 83.1 ± 16.7 0.83* Number of anastomoses 3.39 ± 1.00 3.36 ± 0.99 0.76* Amount of drainage (ml) 361 ± 140 350 ± 129 0.34* Intubation time (h) 5.76 ± 1.41 5.62 ± 1.48 0.25* Stay in the intensive care unit (h) 22.81 ± 3.57 21.00 ± 2.19 0.0001* Total duration of hospital stay (days) 8.96 ± 3.14 6.06 ± 1.61 0.0001* Use of blood products, n (%) 57 (35.4) 261 (32.9) 0.54** Use of inotropic support, n (%) 13 (8.1) 53 (6.7) 0.53** *Student’s t-test, **Pearson’s chi-squared test.
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