Association of Laboratory Parameters with Acute Kidney Injury in Pediatric Patients Undergoing Surgery for Transposition of the Great Arteries

Abstract

Background. Acute kidney injury (AKI) is a serious complication in children undergoing surgery for transposition of the great arteries (TGA) and can adversely affect postoperative outcomes. Early identification of prognostic laboratory indicators may improve detection and prevention. Methods. This prospective study included 150 children (mean age 6 months) undergoing TGA correction at the National Research Cardiac Surgery Center in Astana, Kazakhstan, from January 2021 to December 2023. Participants were divided into experimental and control groups (n = 75 each). Laboratory parameters, including creatinine, urea, electrolytes, C-reactive protein (CRP), and oxidative stress markers, were assessed pre- and postoperatively. Hemodynamic parameters and hourly diuresis were monitored during and after surgery. Logistic regression, correlation analysis, and Kaplan-Meier analysis were used to identify predictors of AKI. Results. Preoperative creatinine (OR = 1.05, 95% CI: 1.02–1.08, p < 0.01) and CRP (OR = 1.08, 95% CI: 1.03–1.13, p < 0.01) were independently associated with AKI development. Median time to AKI onset was shorter in the experimental group (1.5 vs. 2 days, p = 0.03), reflecting earlier detection likely due to more intensive monitoring. Children who developed AKI had longer ICU stays (median 7 vs. 5 days, p < 0.01). Conclusions. Preoperative creatinine and CRP are reliable early indicators of AKI risk in pediatric TGA surgery. Systematic postoperative monitoring of laboratory parameters and diuresis allows timely detection and intervention, potentially improving outcomes. Future multicenter studies are warranted to validate these predictors and optimize risk stratification protocols. Copyright © 2026 Società Editrice Universo (SEU), Roma, Italy. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.