Scholarlink

Background <p>We evaluated whether immediate postoperative urine dipstick occult blood after on-pump cardiac surgery could serve as an early indicator of high-risk cardiac surgery-associated acute kidney injury (CSA-AKI).</p> Methods <p>This single-center retrospective study included 11,782 adult patients undergoing elective on-pump cardiac surgery (2018–2024), excluding those with preoperative chronic kidney disease (CKD, stage 3–5), positive preoperative urine occult blood, or postoperative microscopic hematuria. The primary outcome was any-stage CSA-AKI within 7 days after surgery. Multivariable logistic regression was used to evaluate the independent association between immediate postoperative urine occult blood and CSA-AKI. The predictive value was assessed by C-index, the net reclassification improvement index, and integrated discrimination improvement. The goodness-of-fit of models was evaluated through Akaike information criterion, Bayesian information criterion and likelihood ratio test.</p> Results <p>CSA-AKI occurred in 32.8% of patients, rising progressively across urine occult blood categories from 28.8% (negative group) to 37.9% (3 + group). After multivariable adjustment, 3 + urine occult blood was independently associated with higher odds of any-stage CSA-AKI (adjusted odds ratio [aOR], 1.630; 95% confidence interval [CI], 1.463–1.817; <i>P</i> &lt; 0.001) and early CSA-AKI within 48&#xa0;h (aOR, 1.692; 95% CI, 1.513–1.889; <i>P</i> &lt; 0.001). Both 2 + and 3 + urine occult blood were independently associated with stage 2–3 CSA-AKI. Integrating urine occult blood into a clinical risk model that included established CSA-AKI predictors yielded a modest improvement in prognostic prediction and model fit.</p> Conclusion <p>Immediate postoperative urine dipstick occult blood positivity was independently associated with an increased risk of CSA-AKI. As a simple and easily available biomarker, it may serve as an early indicator to identify patients at high risk of CSA-AKI in this selected cohort of adult patients undergoing elective on-pump cardiac surgery. Because direct markers of hemolysis or urinary heme proteins were not measured, the underlying biological mechanisms remain uncertain and require prospective validation.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Immediate postoperative urine dipstick occult blood positivity: a simple and early indicator of high-risk acute kidney injury after on-pump cardiac surgery

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年5月25日

查看全文
  • Han Zhang,
  • Jing Wang,
  • Tianlong Wang,
  • Jieru Zhang,
  • Jiayu Zou,
  • Zhiyuan Bo,
  • Qiaoni Zhang,
  • Gang Liu,
  • Jian Wang,
  • Yuan Teng,
  • Shujie Yan,
  • Bingyang Ji

摘要

Background

We evaluated whether immediate postoperative urine dipstick occult blood after on-pump cardiac surgery could serve as an early indicator of high-risk cardiac surgery-associated acute kidney injury (CSA-AKI).

Methods

This single-center retrospective study included 11,782 adult patients undergoing elective on-pump cardiac surgery (2018–2024), excluding those with preoperative chronic kidney disease (CKD, stage 3–5), positive preoperative urine occult blood, or postoperative microscopic hematuria. The primary outcome was any-stage CSA-AKI within 7 days after surgery. Multivariable logistic regression was used to evaluate the independent association between immediate postoperative urine occult blood and CSA-AKI. The predictive value was assessed by C-index, the net reclassification improvement index, and integrated discrimination improvement. The goodness-of-fit of models was evaluated through Akaike information criterion, Bayesian information criterion and likelihood ratio test.

Results

CSA-AKI occurred in 32.8% of patients, rising progressively across urine occult blood categories from 28.8% (negative group) to 37.9% (3 + group). After multivariable adjustment, 3 + urine occult blood was independently associated with higher odds of any-stage CSA-AKI (adjusted odds ratio [aOR], 1.630; 95% confidence interval [CI], 1.463–1.817; P < 0.001) and early CSA-AKI within 48 h (aOR, 1.692; 95% CI, 1.513–1.889; P < 0.001). Both 2 + and 3 + urine occult blood were independently associated with stage 2–3 CSA-AKI. Integrating urine occult blood into a clinical risk model that included established CSA-AKI predictors yielded a modest improvement in prognostic prediction and model fit.

Conclusion

Immediate postoperative urine dipstick occult blood positivity was independently associated with an increased risk of CSA-AKI. As a simple and easily available biomarker, it may serve as an early indicator to identify patients at high risk of CSA-AKI in this selected cohort of adult patients undergoing elective on-pump cardiac surgery. Because direct markers of hemolysis or urinary heme proteins were not measured, the underlying biological mechanisms remain uncertain and require prospective validation.