Evidence map›Paper›PMID 38713228›Full record

ArticlePediatric nephrology (Berlin, Germany)2024

Diuretic response after neonatal cardiac surgery: a report from the NEPHRON collaborative.

Joshua J Blinder, Jeffrey Alten, David Bailly, Jason Buckley, Shanelle Clarke, J Wesley Diddle, Xiomara Garcia, Katja M Gist, Joshua Koch, David M Kwiatkowski and 6 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Pediatric nephrology (Berlin, Germany), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Joshua J BlinderDivision of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, 94304, USA. jblinder@stanford.edu.
Jeffrey AltenDivision of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
David BaillyDepartment of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.
Jason BuckleyDivision of Cardiology, Department of Pediatrics, Medical University of South Carolina Children's Hospital, Charleston, SC, USA.
Shanelle ClarkeDivision of Cardiology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
J Wesley DiddleDivision of Cardiac Critical Care Medicine, Department of Anesthesia/Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Xiomara GarciaDivision of Pediatric Cardiology, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AK, USA.
Katja M GistDivision of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
Joshua KochDivision of Critical Care, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ, USA.
David M KwiatkowskiDivision of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, 94304, USA.
A K M Fazlur RahmanDepartment of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
Garrett ReichleDivision of Pediatric Cardiology, Department of Pediatrics, C. S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, MI, USA.
Kevin ValentineDivision of Pediatric Critical Care, Department of Pediatrics, Riley Children's Hospital, Indiana University, Indianapolis, IN, USA.
Kristal M HockSection of Pediatric Cardiac Critical Care, Division of Cardiology, Department of Pediatrics, University of Alabama, Birmingham, Birmingham, AL, USA.
Santiago BorasinoSection of Pediatric Cardiac Critical Care, Division of Cardiology, Department of Pediatrics, University of Alabama, Birmingham, Birmingham, AL, USA.
NEPHRON Collaborators

Funding

Castin’ ‘N Catchin’ Charity Organization
6 · The paper itself

Abstract

backgroundMulticenter early diuretic response (DR) analysis of single furosemide dosing following neonatal cardiac surgery is lacking to inform whether early DR predicts adverse clinical outcomes.

methodsWe performed a retrospective cohort study utilizing data from the NEPHRON registry. Random forest machine learning generated receiver operating characteristic-area under the curve (ROC-AUC) and odds ratios for mechanical ventilation (MV) and respiratory support (RS). Prolonged MV and RS were defined using ≥ 90th percentile of observed/expected ratios. Secondary outcomes were prolonged CICU and hospital length of stay (LOS) and kidney failure (stage III acute kidney injury (AKI), peritoneal dialysis, and/or continuous kidney replacement therapy on postoperative day three) assessed using covariate-adjusted ROC-AUC curves.

resultsA total of 782 children were included. Cumulative urine output (UOP) metrics were lower in prolonged MV and RS patients, but DR poorly predicted prolonged MV (highest AUC 0.611, OR 0.98, sensitivity 0.67, specificity 0.53, p = 0.006, 95% OR CI 0.96-0.99 for cumulative 6-h UOP) and RS (highest AUC 0.674, OR 0.94, sensitivity 0.75, specificity 0.54, p < 0.001, 95% CI 0.91-0.97 UOP between 3 and 6 h). Secondary outcome results were similar. DR had fair discrimination for kidney failure (AUC 0.703, OR 0.94, sensitivity 0.63, specificity 0.71, 95% OR CI 0.91-0.98, p < 0.001, cumulative 6-h UOP).

conclusionsEarly DR poorly discriminated patients with prolonged MV, RS, and LOS in this cohort, though it may identify severe postoperative AKI phenotype. Future work is warranted to determine if early DR or late postoperative DR later, in combination with other AKI metrics, may identify a higher-risk phenotype.

Indexed as

Acute Kidney InjuryCardiac Surgical ProceduresDiureticsFurosemideFemaleHumansInfantInfant, NewbornLength of StayMalePostoperative ComplicationsRegistriesRespiration, ArtificialRetrospective StudiesROC CurveTreatment OutcomeDiureticsFurosemideAcute kidney injuryCardiac surgeryCICUFluid overload

Identifiers

PMID38713228

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.