Serum Lactate and Capillary Refill Time as Predictors of Acute Kidney Injury After Pediatric Cardiovascular Surgery: A Prospective Cohort Study

Serum Lactate and Capillary Refill Time as Predictors of Acute Kidney Injury After Pediatric Cardiovascular Surgery: A Prospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Serum Lactate and Capillary Refill Time as Predictors of Acute Kidney Injury After Pediatric Cardiovascular Surgery: A Prospective Cohort Study Camilo José Cuadros, Vanesa A. Ochoa Jimenez, Ines E. Gómez Hernández, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7576944/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Acute kidney injury (AKI) is a frequent complication after pediatric cardiovascular surgery (CVC) and is associated with higher morbidity and mortality. Early, modifiable predictors are needed to improve outcomes. Methods We conducted a prospective cohort at a high-complexity center in Cali, Colombia (November 2020–July 2022). Children aged 0–60 months undergoing CVC and admitted to the pediatric cardiovascular ICU were included. AKI was defined and staged by KDIGO criteria. Serum lactate and capillary refill time (CRT) were measured pre-operatively, at ICU admission, and at 6, 12, and 24 hours post-operatively. We compared clinical, intra- and post-operative variables between patients with and without AKI using appropriate univariate tests and logistic regression. Results Of 131 patients, 19.1% developed AKI; 69.2% of AKI cases were severe. Twenty-eight-day mortality was 15.3% overall and 52% among patients with AKI. Higher surgical complexity by RACHS-1, elevated serum lactate at 6–12 hours post-op, and prolonged CRT at all time points were associated with AKI. Lactate at admission (OR 2.88; 95% CI 1.2–7.0), 6 h (3.63; 1.5–9.0) and 12 h (2.84; 1.1–7.1), and prolonged CRT at admission (2.09; 1.0–4.2), 6 h (2.10; 1.2–3.7) and 12 h (2.42; 1.4–4.2) were significant predictors. Conclusions In this cohort, postoperative tissue-perfusion markers—elevated serum lactate and prolonged CRT—were associated with AKI following pediatric CVC. These accessible bedside measures may support early risk stratification and targeted kidney-protective strategies. Acute kidney injury congenital heart surgery serum lactate capillary refill time pediatric critical care RACHS-1 Full Text Supplementary Files GraphicalabstractAKIposCVV.pptx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major Revisions Needed 06 Oct, 2025 Reviewers agreed at journal 13 Sep, 2025 Reviewers invited by journal 13 Sep, 2025 Editor assigned by journal 11 Sep, 2025 First submitted to journal 09 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7576944","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":514643801,"identity":"0745375c-f76b-4973-a636-41a407c22534","order_by":0,"name":"Camilo José Cuadros","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYFCCA0DMBsTsDUDCwIIULTwghoEEsTaBtEgkgFhEaOFvPPxM4kfZPTn5mc+vbvhRIMHA396dgFeLxIFjZpI954qNDW7nlN3sATpM4szZDXi1GDCcYZPgbUtI3CCdk3aDB6jFQCKXsBbJv0At82eeSbv5h1gt0iBbGm6wH7tNlC1Avxhby5xLMDY4k8N2W8ZAgoegX/hnHH54801Zgpx8+/FnN9/8sZHjb+/FrwVoDYzFYwAm8SsHW9MAY7E/IKx6FIyCUTAKRiQAAMFOR32/iPXRAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-4030-5808","institution":"Fundación Valle del Lili: Fundacion Valle del Lili","correspondingAuthor":true,"prefix":"","firstName":"Camilo","middleName":"José","lastName":"Cuadros","suffix":""},{"id":514643802,"identity":"09e84dcb-c583-44e6-9a4c-5f645d5fb489","order_by":1,"name":"Vanesa A. 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Early, modifiable predictors are needed to improve outcomes.\n\nMethods\n\nWe conducted a prospective cohort at a high-complexity center in Cali, Colombia (November 2020–July 2022). Children aged 0–60 months undergoing CVC and admitted to the pediatric cardiovascular ICU were included. AKI was defined and staged by KDIGO criteria. Serum lactate and capillary refill time (CRT) were measured pre-operatively, at ICU admission, and at 6, 12, and 24 hours post-operatively. We compared clinical, intra- and post-operative variables between patients with and without AKI using appropriate univariate tests and logistic regression.\n\nResults\n\nOf 131 patients, 19.1% developed AKI; 69.2% of AKI cases were severe. Twenty-eight-day mortality was 15.3% overall and 52% among patients with AKI. Higher surgical complexity by RACHS-1, elevated serum lactate at 6–12 hours post-op, and prolonged CRT at all time points were associated with AKI. Lactate at admission (OR 2.88; 95% CI 1.2–7.0), 6 h (3.63; 1.5–9.0) and 12 h (2.84; 1.1–7.1), and prolonged CRT at admission (2.09; 1.0–4.2), 6 h (2.10; 1.2–3.7) and 12 h (2.42; 1.4–4.2) were significant predictors.\n\nConclusions\n\nIn this cohort, postoperative tissue-perfusion markers—elevated serum lactate and prolonged CRT—were associated with AKI following pediatric CVC. These accessible bedside measures may support early risk stratification and targeted kidney-protective strategies.","manuscriptTitle":"Serum Lactate and Capillary Refill Time as Predictors of Acute Kidney Injury After Pediatric Cardiovascular Surgery: A Prospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-19 06:40:34","doi":"10.21203/rs.3.rs-7576944/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major Revisions Needed","date":"2025-10-06T05:06:01+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2025-09-13T21:06:20+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-13T16:56:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-11T08:04:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Nephrology","date":"2025-09-09T16:32:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pnep","sideBox":"Learn more about [Pediatric Nephrology](http://link.springer.com/journal/467)","snPcode":"467","submissionUrl":"https://www.editorialmanager.com/pnep/default2.aspx","title":"Pediatric Nephrology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"7a3aa96f-6e0c-4b5c-a2c7-197307939328","owner":[],"postedDate":"September 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-01T10:35:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-19 06:40:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7576944","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7576944","identity":"rs-7576944","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}