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Figure Legends
Figure 1-a and 1-b. Perioperative serum free hemoglobin and haptoglobin
concentrations.
These two figures show the time courses of perioperative serum free hemoglobin (figure
1-a) and haptoglobin (figure 1-b) concentrations at the following 6 time points: 1) after
anesthesia induction (Pre), 2) 1 hour after initiation of CPB (CPB1hr), 3) 2 hours after
initiation of CPB (CPB2hr), 4) 30 minutes after weaning from CPB (pCPB0.5hr), 5) 2
hours after weaning from CPB (pCPB2hr), and 6) the morning of postoperative day 1
(POD 1).
Figure 2. Comparisons of perioperative serum free hemoglobin concentrations in patients
with and those without AKI.
This figure shows a comparison of perioperative serum free hemoglobin concentrations
in patients with and those without AKI at the following 6 time points: 1) after anesthesia
induction (Pre), 2) 1 hour after initiation of CPB (CPB1hr), 3) 2 hours after initiation of
CPB (CPB2hr), 4) 30 minutes after weaning from CPB (pCPB0.5hr), 5) 2 hours after
weaning from CPB (pCPB2hr), and 6) the morning of postoperative day 1 (POD 1). White
box plots indicate the values for patients without AKI and black box plots indicate the
values for patients with AKI. * means p<0.05.
AKI: acute kidney injury, CPB: cardiopulmonary bypass.
Figure 3. Comparison of perioperative serum haptoglobin concentrations in patients with
and those without AKI.
22
This figure shows a comparison of perioperative serum haptoglobin concentrations in
patients with and those without AKI at the following 6 time points: 1) after anesthesia
induction (Pre), 2) 1 hour after initiation of CPB (CPB1hr), 3) 2 hours after initiation of
CPB (CPB2hr), 4) 30 minutes after weaning from CPB (pCPB0.5hr), 5) 2 hours after
weaning from CPB (pCPB2hr), and 6) the morning of postoperative day 1 (POD 1). White
box plots indicate the values for patients without AKI and black box plots indicate the
values for patients with AKI. * means p<0.05.
AKI: acute kidney injury, CPB: cardiopulmonary bypass.
Figure 4-a and 4-b. Adjusted odds ratios of perioperative serum free hemoglobin and
haptoglobin concentrations for the risk of AKI.
These two figures show the time courses of adjusted odds ratios for perioperative serum
free hemoglobin (figure 4-a) and haptoglobin (figure 4-b) levels at the following 6 time
points: 1) after anesthesia induction (Pre), 2) 1 hour after initiation of CPB (CPB1hr), 3)
2 hours after initiation of CPB (CPB2hr), 4) 30 minutes after weaning from CPB
(pCPB0.5hr), 5) 2 hours after weaning from CPB (pCPB2hr), and 6) the morning of
postoperative day 1 (POD1).
Supplemental figure. Study flow.
CPB: cardiopulmonary bypass, sCr: serum creatinine, RRT: renal replacement therapy,
PCPS: percutaneous cardiopulmonary support, ICU: intensive care unit, AKI: acute
kidney injury
23
Table 1. Characteristics of patients with and those without postoperative AKI
With AKI
Without AKI
(n=25)
(n=49)
75 (67-83）
67 (62-76)
0.01
6(24%)
18(36.7%)
0.27
Height (cm)
162 (150-168)
163 (156-170)
0.41
Weight (kg)
59.5 (52.3-66)
56.2(48-65)
0.76
3(2-3)
3(2-3)
0.34
2.81 (1.98-5)
2.62(1.6-4.8)
0.22
Hypertension, n. (%)
15(60%)
32(65.3%)
0.65
Diabetes mellitus, n. (%)
4(16%)
5(10.2%)
0.47
54.8(45.3-68.1)
65.7 (53.4-78.2)
0.04
64 (59-71)
61 (55.4-66.5)
0.23
Operation time (mins)
322 (276-389)
315(261-368)
0.34
Cross-clamp time (mins)
108 (80-148)
104 (79-131)
0.54
Duration of CPB (mins)
176 (141-213)
169 (132-202)
0.46
51.3(43.9-63.4)
54.5(45.3-64.8)
0.49
Age (years)
Female, n. (%)
ASA-PS
EuroSCORE II
Preoperative eGFR
P value
(ml/min/1.73m2)
LVEF(%)
Mean perfusion pressure during
CPB (mmHg)
Transfusion (RCC) (unit)
6(6-10)
6(2-8)
0.06
Transfusion (FFP) (unit)
6(4-10)
6(0-10)
0.63
Type of procedure, n. (%)
0.74
Total arch replacement
6(24%)
14(28.6%)
Valve surgery
17(68%)
29(59.2%)
2 (8%)
6(12.2%)
Total arch replacement
+Valve surgery
AKI: acute kidney injury, ASA-PS: American Society of Anesthesiology physical
status, EuroSCOREⅡ: European System for Cardiac Operative Risk Evaluation II,
eGFR: estimated glomerular filtration rate, LVEF: left ventricular ejection fraction,
TAR: total arch replacement.
Table 2. Area under receiver operator characteristic curve of perioperative serum free
hemoglobin levels for the risk of postoperative acute kidney injury.
Area under
Estimated optimal
ROC curve (95%CI)
cut off value
Pre
0.53 (0.40, 0.67)
CPB1hr
sensitivity
specificity
0.02
0.76
0.37
0.74 (0.62, 0.87)
0.06
0.64
0.74
CPB2hr
0.68 (0.54, 0.83)
0.09
0.58
0.79
pCPB0.5hr
0.80(0.70, 0.91)
0.12
0.60
0.88
pCPB2hr
0.80 (0.70, 0.90)
0.09
0.60
0.88
POD1
0.54(0.40, 0.68)
0.04
0.24
0.86
maxfHb
0.81(0.71, 0.91)
0.12
0.76
0.88
ROC: receiver operator characteristic, CPB: cardiopulmonary bypass, pCPB: post
cardiopulmonary bypass, POD: postoperative day, maxfHb: maximum plasma free
hemoglobin level during the study period
Table 3 Multivariate analysis for the risk of pAKI
Adjusted odds ratio
(95%CI)
P value
maxfHb (10mg/dL)
1.33 (1.12, 1.58)
0.001
minHp (mg/dL)
0.95 (0.91, 1.00)
0.03
Age (years old)
1.06 (0.99, 1.12)
0.08
Preoperative eGFR (ml/min1/1.73m2)
1.00 (0.97, 1.04)
0.99
Variables
pAKI: postoperative acute kidney injury, maxfHb: maximum serum free hemoglobin
level during the study period, minHp: minimum serum haptoglobin level during the
study period, eGFR: estimated glomerular filtration rate
...
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