Prognostic model of integral renal risk in infants after correction of congenital heart defects

Abstract

Renal complications and subclinical renal stress are frequent components of the early postoperative period in infants after cardiac surgical correction of congenital heart defects and require early risk stratification.

Objective – to develop a prognostic scoring index for assessing the integral renal risk index in infants after correction of congenital heart defects in the early postoperative period.

Materials and methods. A retrospective single‑center descriptive‑analytical study was conducted (n=101; age 1 – 12 months). The dependent variable was the integral renal risk index (a continuous scale of integral renal risk or stress) formed within the analysis of the early postoperative period. The following predictors were considered: disease severity, physical development as a proxy for nutritional status, class or complexity of the surgical intervention, syndromic or genetic features, creatinine level, and left ventricular ejection fraction. Multiple linear regression was constructed with diagnostics of assumptions (normality of residuals, linearity, homoscedasticity, multicollinearity assessed by the variance inflation factor, and influential observations).

Results. The model was statistically significant (F(6,  94)=9.82; p<0.001) and explained 38.5% of the variance in risk (adjusted R²=0.346). The largest independent contribution was made by the operation class (surgical complexity) (b=0.578; p<0.001), whereas ejection fraction demonstrated an inverse association with risk (b=–0.0167; p=0.016).

Conclusions. A scoring index, X, defined by a formula and within‑cohort thresholds (X>1 – high risk; X>1.5 – very high risk), is proposed. This index integrates perioperative burden and perfusion reserve and may be used for early nephroprotective management.