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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introdu&#231;&#227;o</span><p id="par0055" class="elsevierStylePara elsevierViewall">As cardiopatias cong&#233;nitas representam a anomalia cong&#233;nita mais frequente e ocorrem&#44; globalmente&#44; em cerca de 0&#44;8&#37; dos nados vivos&#46; Estima&#8208;se que metade destes doentes ir&#227;o necessitar de corre&#231;&#227;o cir&#250;rgica e alguns deles poder&#227;o apresentar&#8208;se em condi&#231;&#227;o cr&#237;tica&#44; sobretudo no per&#237;odo neonatal<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A insufici&#234;ncia renal aguda &#40;IRA&#41; &#233; comum no contexto da cirurgia card&#237;aca pedi&#225;trica&#44; com uma preval&#234;ncia estimada de 5&#8208;33&#37;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a>&#46; Est&#225;&#8208;lhe associada uma importante morbilidade e uma mortalidade que ronda os 20&#8208;79&#37;&#44; dependendo da defini&#231;&#227;o de IRA utilizada<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a>&#46; A patog&#233;nese da insufici&#234;ncia renal neste contexto &#233; ainda desconhecida&#44; tendo provavelmente uma origem multifatorial que inclui o baixo d&#233;bito card&#237;aco&#44; a hipoxemia&#44; a inflama&#231;&#227;o e a utiliza&#231;&#227;o de medica&#231;&#227;o nefrot&#243;xica<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a>&#46; Estudos retrospetivos sugerem que a insufici&#234;ncia renal associada &#224; cirurgia card&#237;aca pode ter um impacto n&#227;o apenas no progn&#243;stico a curto prazo&#44; mas tamb&#233;m no desenvolvimento de insufici&#234;ncia renal cr&#243;nica<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a>&#46; A redu&#231;&#227;o da incid&#234;ncia de IRA neste contexto requer&#44; assim&#44; um conhecimento profundo da sua patofisiologia e dos fatores de risco que lhe s&#227;o inerentes&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Os objetivos deste estudo foram os de &#40;1&#41; caracterizar&#44; no nosso centro&#44; a epidemiologia e fatores de risco associados &#224; ocorr&#234;ncia de IRA no p&#243;s&#8208;operat&#243;rio card&#237;aco pedi&#225;trico e &#40;2&#41; determinar o seu impacto na dura&#231;&#227;o da ventila&#231;&#227;o mec&#226;nica invasiva&#44; dura&#231;&#227;o do internamento na Unidade de Cuidados Intensivos Card&#237;acos &#40;UCIC&#41; e na mortalidade intra&#8208;hospitalar&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Pretendemos ainda &#40;3&#41; desenvolver um modelo de regress&#227;o log&#237;stica capaz de predizer o risco de IRA de forma controlada e objetiva&#44; baseado em par&#226;metros cl&#237;nicos e laboratoriais f&#225;ceis de obter&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Desenho do estudo e sele&#231;&#227;o da popula&#231;&#227;o</span><p id="par0075" class="elsevierStylePara elsevierViewall">Estudo monoc&#234;ntrico&#44; observacional e retrospetivo&#44; a partir da recolha de dados nos processos cl&#237;nicos de doentes consecutivos submetidos a cirurgia card&#237;aca no nosso centro&#44; entre janeiro de 2010 e dezembro de 2012&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos todos os doentes com cardiopatia cong&#233;nita &#40;CC&#41; e idade inferior a 18 anos&#44; e exclu&#237;dos aqueles com doen&#231;a renal pr&#233;via &#224; cirurgia&#44; hist&#243;ria de di&#225;lise ou transplante renal&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Vari&#225;veis cl&#237;nicas e laboratoriais</span><p id="par0085" class="elsevierStylePara elsevierViewall">As vari&#225;veis pr&#233;&#8208;operat&#243;rias inclu&#237;ram&#58; idade &#224; data da cirurgia&#44; sexo&#44; peso&#44; altura&#44; tipo de CC &#40;classificada como cian&#243;tica&#47;acian&#243;tica&#41; e valor s&#233;rico de creatinina e ureia registado nas an&#225;lises pr&#233;&#8208;operat&#243;rias&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">As vari&#225;veis intraoperat&#243;rias inclu&#237;ram&#58; tempo de <span class="elsevierStyleItalic">bypass</span> cardiopulmonar &#40;minutos &#91;min&#93;&#41;&#44; tempo de clampagem a&#243;rtica &#40;min&#41; e tempo de paragem cardiorrespirat&#243;ria &#40;min&#41;&#46; Foi utilizado o <span class="elsevierStyleItalic">score</span> de Arist&#243;teles na categoriza&#231;&#227;o da complexidade cir&#250;rgica &#40;1&#8208;4&#41;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">As vari&#225;veis p&#243;s&#8208;operat&#243;rias inclu&#237;ram&#58; valores s&#233;ricos de creatinina&#44; ureia e lactatos registados no primeiro dia de p&#243;s&#8208;operat&#243;rio&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">O <span class="elsevierStyleItalic">score</span> inotr&#243;pico no p&#243;s&#8208;operat&#243;rio foi calculado de acordo com a f&#243;rmula proposta por Maarslet et al&#46;&#58; 1<span class="elsevierStyleHsp" style=""></span>x dopamina &#40;&#956;g&#47;kg&#47;min&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>dobutamina &#40;&#956;g&#47;kg&#47;min&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>milrinona &#40;&#956;g&#47;kg&#47;min&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span> &#40;&#956;g&#47;kg&#47;min&#41;&#44; e categorizado em dois grupos&#58;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>8 &#40;<span class="elsevierStyleItalic">score</span> inotr&#243;pico baixo&#41; e<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>8 &#40;<span class="elsevierStyleItalic">score</span> inotr&#243;pico alto&#41;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Foram tamb&#233;m inclu&#237;das a necessidade de ventila&#231;&#227;o mec&#226;nica invasiva<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>48<span class="elsevierStyleHsp" style=""></span>h de p&#243;s&#8208;operat&#243;rio&#44; dura&#231;&#227;o de internamento na UCIC &#40;dias&#41;&#44; necessidade de di&#225;lise peritoneal e ocorr&#234;ncia de morte intra&#8208;hospitalar&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Defini&#231;&#227;o de insufici&#234;ncia renal aguda</span><p id="par0110" class="elsevierStylePara elsevierViewall">A IRA foi definida de acordo com os crit&#233;rios do <span class="elsevierStyleItalic">Pediatric&#8208;Modified Risk Injury Failure Loss and End&#8208;Stage renal disease</span> &#40;p&#8208;RIFLE&#41;&#44; que se baseiam na redu&#231;&#227;o p&#243;s&#8208;operat&#243;ria da taxa de filtra&#231;&#227;o glomerural &#40;TFG&#41;&#44; relativamente &#224; TFG basal<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a>&#46; Esta classifica&#231;&#227;o derivou de consenso de especialistas e encontra&#8208;se validada em crian&#231;as com CC<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Foi utilizada a f&#243;rmula Schwartz modificada para o c&#225;lculo da TFG nestes doentes<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">9&#44;10</span></a>&#46; Foi considerado como valor basal de creatinina s&#233;rica aquele obtido nas an&#225;lises pr&#233;&#8208;operat&#243;rias &#40;colhidas nas 48<span class="elsevierStyleHsp" style=""></span>h que precederam a cirurgia&#41;&#46; A TFG p&#243;s&#8208;operat&#243;ria foi calculada com base no valor de creatinina s&#233;rica registado no primeiro dia de p&#243;s&#8208;operat&#243;rio&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A cada doente foi atribu&#237;da uma classe de p&#8208;RIFLE&#58; risco de insufici&#234;ncia renal &#40;R&#41;&#44; insufici&#234;ncia renal &#40;<span class="elsevierStyleSmallCaps">I</span>&#41; ou fal&#234;ncia renal &#40;F&#41;&#44; de acordo com a varia&#231;&#227;o p&#243;s&#8208;operat&#243;ria da sua <span class="elsevierStyleItalic">clearance</span> de creatininina&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">As classes R&#44; L e F correspondem a uma diminui&#231;&#227;o da TFG de respetivamente 25&#44; 50 e 75&#37; relativamente ao valor basal pr&#233;&#8208;cir&#250;rgico&#46; Aos doentes com um valor p&#243;s&#8208;operat&#243;rio de TFG<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> foi atribu&#237;da a classe p&#8208;RIFLE &#40;F&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Todos os doentes inclu&#237;dos nas classes I e F de p&#8208;RIFLE foram considerados como tendo desenvolvido insufici&#234;ncia renal p&#243;s&#8208;operat&#243;ria&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">O d&#233;bito urin&#225;rio n&#227;o foi utilizado como crit&#233;rio de insufici&#234;ncia renal nesta coorte&#44; por ser reconhecidamente influenciado por fatores intra e p&#243;s&#8208;operat&#243;rios&#44; tais como o uso de diur&#233;ticos&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lise estat&#237;stica</span><p id="par0140" class="elsevierStylePara elsevierViewall">As vari&#225;veis cont&#237;nuas s&#227;o apresentadas como m&#233;dias e desvio padr&#227;o quando obedecendo a distribui&#231;&#227;o normal&#44; e como medianas&#44; m&#237;nimo e m&#225;ximo quando n&#227;o obedecendo a distribui&#231;&#227;o normal&#46; As vari&#225;veis categ&#243;ricas s&#227;o descritas de acordo com a sua frequ&#234;ncia e percentagem&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Foram usados o teste T de Student ou o teste de Mann&#8208;Whitney na an&#225;lise univariada das vari&#225;veis cont&#237;nuas&#44; e o teste de &#967;<span class="elsevierStyleSup">2</span> ou o teste exato de Fisher na an&#225;lise das vari&#225;veis categ&#243;ricas&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">A an&#225;lise multifatorial foi realizada atrav&#233;s da constru&#231;&#227;o de um modelo de regress&#227;o log&#237;stica&#46; A ocorr&#234;ncia de IRA p&#243;s&#8208;operat&#243;ria foi definida como vari&#225;vel dependente&#46; Ap&#243;s a an&#225;lise de modelos preliminares&#44; foi constru&#237;do um modelo que incluiu como vari&#225;veis preditoras &#40;independentes&#44; controladas&#41;&#58; idade &#224; data da cirurgia &#40;anos&#41; e valores s&#233;ricos de creatinina &#40;mg&#47;dL&#41;&#44; ureia &#40;mg&#47;dL&#41; e lactatos &#40;mg&#47;dL&#41;&#44; registados no primeiro dia de p&#243;s&#8208;operat&#243;rio&#46; Cada uma das vari&#225;veis preditoras foi selecionada ap&#243;s confirma&#231;&#227;o da independ&#234;ncia da sua associa&#231;&#227;o univariada com a ocorr&#234;ncia de IRA p&#243;s&#8208;operat&#243;ria&#46; A robustez do modelo foi avaliada atrav&#233;s do teste de Hosmer&#8208;Lemeshow&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Em todas as an&#225;lises foi considerado estatisticamente significativo um valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Foi utilizado na an&#225;lise estat&#237;stica o <span class="elsevierStyleItalic">software</span> SPSS&#174; &#40;v 20&#46;0&#59; IBM SPSS <span class="elsevierStyleItalic">Software for Predictive Analytics</span>&#59; SPSS&#44; Chicago&#44; IL&#44; EUA&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Epidemiologia da insufici&#234;ncia renal no p&#243;s&#8208;operat&#243;rio card&#237;aco</span><p id="par0160" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos 325 doentes&#44; com uma mediana de idades de tr&#234;s anos &#91;um dia&#59; 18 anos&#93;&#44; 7&#44;7&#37; de rec&#233;m&#8208;nascidos&#46; Cento e setenta e quatro &#40;53&#44;5&#37;&#41; doentes eram do sexo masculino&#44; 104 &#40;32&#37;&#41; tinham uma CC cian&#243;tica e 283 &#40;87&#37;&#41; foram submetidos a cirurgia card&#237;aca sob <span class="elsevierStyleItalic">bypass</span> cardiopulmonar&#46; A maioria &#40;68&#44;9&#37;&#41; tinha um <span class="elsevierStyleItalic">score</span> de complexidade cir&#250;rgica de Arist&#243;teles &#8805;<span class="elsevierStyleHsp" style=""></span>2&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Quarenta &#40;12&#44;3&#37;&#41; doentes desenvolveram IRA no primeiro dia de p&#243;s&#8208;operat&#243;rio&#46; Destes&#44; 31 foram classificados como classe I &#40;Insufici&#234;ncia renal&#41; e nove como classe F &#40;fal&#234;ncia renal&#41; de p&#8208;RIFLE&#46; A maioria &#40;67&#37;&#41; dos seis doentes submetidos a di&#225;lise peritoneal integrava a classe F de p&#8208;RIFLE&#46; Nove &#40;70&#37;&#41; dos 13 doentes falecidos no p&#243;s&#8208;operat&#243;rio pertenciam ao grupo com insufici&#234;ncia renal &#40;classe I ou classe F&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Fatores de risco para a ocorr&#234;ncia de insufici&#234;ncia renal</span><p id="par0170" class="elsevierStylePara elsevierViewall">Os doentes que desenvolveram insufici&#234;ncia renal no p&#243;s&#8208;operat&#243;rio eram mais jovens&#44; mais leves e tinham um valor de creatinina s&#233;rica basal mais baixo &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; <span class="elsevierStyleItalic">Scores</span> de complexidade cir&#250;rgica altos e tempo de <span class="elsevierStyleItalic">bypass</span> cardiopulmonar prolongado &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; estiveram associados de forma significativa &#224; ocorr&#234;ncia de insufici&#234;ncia renal nesta popula&#231;&#227;o&#46; Pelo contr&#225;rio&#44; o tempo de clampagem a&#243;rtica n&#227;o revelou uma associa&#231;&#227;o significativa com a ocorr&#234;ncia de insufici&#234;ncia renal &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;08&#41; &#8211; <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">O risco de desenvolver IRA foi cerca de 6&#44;6 vezes superior nos rec&#233;m&#8208;nascidos do que nas crian&#231;as com idade<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>13 anos &#40;<span class="elsevierStyleItalic">odds ratio</span> &#91;OR&#93; 7&#44;615&#59; intervalo de confian&#231;a &#91;IC&#93; 95&#37;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;977&#8208;59&#44;370&#41;&#59; cerca do dobro nos doentes com CC cian&#243;tica &#40;OR 2&#44;125&#59; IC 95&#37;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;197&#8208;3&#44; 774&#41; e cerca de 3&#44;3 vezes superior em doentes com um <span class="elsevierStyleItalic">score</span> inotr&#243;pico alto &#40;OR 4&#44;304&#59; IC 95&#37;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;405&#8208;7&#44;7&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Impacto progn&#243;stico</span><p id="par0180" class="elsevierStylePara elsevierViewall">A ocorr&#234;ncia de IRA no p&#243;s&#8208;operat&#243;rio card&#237;aco associou&#8208;se significativamente a um prolongamento do internamento na UCIC e da ventila&#231;&#227;o mec&#226;nica invasiva &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">No grupo que n&#227;o desenvolveu IRA&#44; a dura&#231;&#227;o mediana do internamento na UCIC foi de tr&#234;s dias &#91;um&#59; 36 dias&#93;&#46; Cinquenta e cinco doentes &#40;19&#44;3&#37;&#41; permaneceram sob ventila&#231;&#227;o mec&#226;nica invasiva por um per&#237;odo superior a 48<span class="elsevierStyleHsp" style=""></span>h e registaram&#8208;se quatro &#243;bitos &#40;1&#44;4&#37;&#41;&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Por outro lado&#44; o grupo que desenvolveu IRA no p&#243;s&#8208;operat&#243;rio card&#237;aco teve uma dura&#231;&#227;o mediana de internamento na UCI de 6&#44;5 dias &#91;um&#59; 30 dias&#93;&#46; Vinte e um doentes &#40;52&#44;5&#37;&#41; permaneceram sob ventila&#231;&#227;o mec&#226;nica invasiva por um per&#237;odo superior a 48<span class="elsevierStyleHsp" style=""></span>h e registaram&#8208;se nove &#243;bitos &#40;22&#44;5&#37;&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">De facto&#44; a ocorr&#234;ncia de IRA resultou num risco de mortalidade cerca de 13&#44;3 vezes superior dos doentes com les&#227;o renal aguda &#40;OR 14&#44;285&#59; IC 95&#37;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;97&#8208;51&#44;45&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Modelo de regress&#227;o log&#237;stica</span><p id="par0200" class="elsevierStylePara elsevierViewall">Um total de 307 casos foram inclu&#237;dos na an&#225;lise de regress&#227;o log&#237;stica&#59; 18 casos &#40;5&#44;5&#37; da amostra&#41; foram exclu&#237;dos por informa&#231;&#227;o incompleta&#44; uma vez que o modelo n&#227;o admite <span class="elsevierStyleItalic">missings</span>&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">O modelo completo &#40;que incluiu como vari&#225;veis preditoras&#58; idade em anos e os valores s&#233;ricos de creatinina &#91;mg&#47;dL&#93;&#44; ureia &#91;mg&#47;dL&#93; e lactatos &#91;mg&#47;dL&#93; registados no primeiro dia de p&#243;s&#8208;operat&#243;rio&#41; previu de forma significativa a ocorr&#234;ncia de IRA no p&#243;s&#8208;operat&#243;rio card&#237;aco &#40;<span class="elsevierStyleItalic">omnibus chi&#8208;square</span>&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#8211; <a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0210" class="elsevierStylePara elsevierViewall">A robustez do modelo foi avaliada atrav&#233;s do teste de Hosmer&#8208;Lemeshow &#40;H<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;25&#59; df<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">0</span>&#46;834&#41;&#46; O modelo mostrou refletir com acuidade a verdadeira ocorr&#234;ncia de IRA na nossa amostra&#44; uma vez que o valor de p neste teste foi consideravelmente<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; A &#225;rea sob a curva ROC foi de 0&#44;909 &#40;IC 95&#37;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;866&#8208;0&#44;951&#41;&#44; significando que 90&#44;9&#37; das previs&#245;es do modelo foram corretas &#8211; <a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0215" class="elsevierStylePara elsevierViewall">O modelo encontra&#8208;se expresso na equa&#231;&#227;o&#58; <span class="elsevierStyleItalic">logit</span> &#40;IRA&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>EXP &#40;&#8211;5&#44;976<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>3&#44;173&#42;creatinina<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#44;059&#42;ureia<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#42;lactatos<span class="elsevierStyleHsp" style=""></span>&#8211;<span class="elsevierStyleHsp" style=""></span>0&#44;249&#42;idade&#41;&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discuss&#227;o</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Padr&#245;es de insufici&#234;ncia renal</span><p id="par0220" class="elsevierStylePara elsevierViewall">Este estudo corrobora a evid&#234;ncia atual e mostra que a IRA no p&#243;s&#8208;operat&#243;rio card&#237;aco &#233; frequente&#44; com uma incid&#234;ncia de 12&#44;3&#37; nesta amostra&#46; A insufici&#234;ncia renal ocorre muito precocemente no decurso do internamento na UCIC&#44; mais frequentemente nos dois primeiros dias de p&#243;s&#8208;operat&#243;rio&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">De facto&#44; Zapitelli et al&#46; demonstraram&#44; numa coorte de crian&#231;as submetidas a cirurgia card&#237;aca&#44; que a insufici&#234;ncia renal era infrequente naqueles em que n&#227;o se verificasse eleva&#231;&#227;o da creatinina s&#233;rica nos dois primeiros dias de p&#243;s&#8208;operat&#243;rio &#40;com valores preditivos negativos de 87&#37; em D1 e 98&#37; em D2 de p&#243;s&#8208;operat&#243;rio&#41;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Este padr&#227;o epidemiol&#243;gico difere daquele registado na popula&#231;&#227;o adulta<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> e sugere a import&#226;ncia do reconhecimento precoce dos doentes suscet&#237;veis&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">No nosso estudo&#44; a escolha do valor de creatinina no primeiro dia de p&#243;s&#8208;operat&#243;rio como vari&#225;vel preditora teve como objetivos a sua uniformiza&#231;&#227;o e a diminui&#231;&#227;o do impacto de fatores de confundimento relacionados com a terap&#234;utica institu&#237;da ap&#243;s a cirurgia&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Por outro lado&#44; achou&#8208;se interessante desenvolver uma ferramenta de <span class="elsevierStyleItalic">screening</span> que permitisse identificar de forma precoce os doentes vulner&#225;veis a les&#227;o renal&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">A an&#225;lise dos fatores de risco pr&#233;&#8208;operat&#243;rios demonstrou que as crian&#231;as mais jovens apresentam um superior risco de desenvolvimento de insufici&#234;ncia renal&#46; Este achado &#233; facilmente justificado pelo facto da TFG m&#225;xima s&#243; ser atingida por volta dos dois anos de idade&#46; Assim&#44; crian&#231;as com idade inferior s&#227;o mais suscet&#237;veis &#224;s agress&#245;es isqu&#233;micas e inflamat&#243;rias decorrentes da cirurgia card&#237;aca<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Na nossa amostra&#44; o grupo que desenvolveu IRA apresentava uma creatinina s&#233;rica pr&#233;&#8208;operat&#243;ria mais baixa&#44; provavelmente resultante da idade mais jovem&#44; menor massa muscular e pior estado nutricional destas crian&#231;as&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">A defini&#231;&#227;o de insufici&#234;ncia renal por n&#243;s usada apoia&#8208;se na varia&#231;&#227;o&#44; relativamente ao valor basal&#44; da TFG estimada&#46; Apesar de ser uma defini&#231;&#227;o globalmente aceite<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a>&#44; a creatinina tem limita&#231;&#245;es como biomarcador de insufici&#234;ncia renal&#44; sobretudo em crian&#231;as pequenas&#46; Nesta coorte&#44; o d&#233;bito urin&#225;rio n&#227;o foi utilizado como crit&#233;rio de insufici&#234;ncia renal por ser reconhecidamente influenciado por fatores intra e p&#243;s&#8208;operat&#243;rios&#46; Numa popula&#231;&#227;o pedi&#225;trica&#44; Akcan&#8208;Arikan et al&#46; demonstraram que a classifica&#231;&#227;o de insufici&#234;ncia renal baseada na varia&#231;&#227;o da TFG n&#227;o se alterava substancialmente pela adi&#231;&#227;o do crit&#233;rio de d&#233;bito urin&#225;rio<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a>&#46; Por outro lado&#44; Mammen et al&#46; mostraram que as varia&#231;&#245;es da creatinina s&#233;rica s&#227;o mais sens&#237;veis do que o d&#233;bito urin&#225;rio na identifica&#231;&#227;o de insufici&#234;ncia renal inicial<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">A etiologia da insufici&#234;ncia renal no contexto de <span class="elsevierStyleItalic">bypass</span> cardiopulmonar prende&#8208;se com a hipoperfus&#227;o&#44; a inflama&#231;&#227;o e a n&#227;o pulsatilidade do fluxo renal&#44; causadoras de vasocontri&#231;&#227;o e isquemia&#46; Consistente com o exposto&#44; este estudo revelou uma maior incid&#234;ncia de insufici&#234;ncia renal em doentes com um <span class="elsevierStyleItalic">score</span> de complexidade cir&#250;rgica mais elevado e um tempo de <span class="elsevierStyleItalic">bypass</span> mais prolongado&#46; Apesar disto&#44; mesmo doentes submetidos a cirurgia card&#237;aca sem circula&#231;&#227;o extracorporal partilham o risco aumentado de desenvolver IRA&#44; sugerindo a exist&#234;ncia de mecanismos patol&#243;gicos alternativos<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">A ocorr&#234;ncia de IRA no p&#243;s&#8208;operat&#243;rio card&#237;aco associou&#8208;se a um prolongamento do tempo de internamento na UCIC e da ventila&#231;&#227;o mec&#226;nica invasiva&#44; sugerindo a rela&#231;&#227;o com um maior consumo de recursos hospitalares e aumento dos custos&#46; Por &#250;ltimo&#44; a IRA aumentou significativamente o risco de morte intra&#8208;hospitalar&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Modelo de regress&#227;o log&#237;stica</span><p id="par0270" class="elsevierStylePara elsevierViewall">A estratifica&#231;&#227;o do risco de IRA pode apoiar&#8208;se em vari&#225;veis cl&#237;nicas e laboratoriais de f&#225;cil obten&#231;&#227;o&#44; sendo razo&#225;vel admitir uma melhoraria no progn&#243;stico destes doentes com uma interven&#231;&#227;o cl&#237;nica mais precoce&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">De facto&#44; o modelo de regress&#227;o log&#237;stica demonstrou&#8208;se robusto na predi&#231;&#227;o do risco de IRA&#44; com uma sensibilidade e especificidade m&#225;ximas combinadas de 82&#44;1 e 75&#44;4&#37;&#46; Apesar do modelo ter validade interna&#44; ser&#225; necess&#225;rio ser testado numa popula&#231;&#227;o distinta daquela a partir da qual foi desenvolvido&#44; para comprovar a sua validade ecol&#243;gica&#46; Os nossos planos de investiga&#231;&#227;o futura passam&#44; assim&#44; por uma valida&#231;&#227;o prospetiva do modelo&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Limita&#231;&#245;es do estudo</span><p id="par0280" class="elsevierStylePara elsevierViewall">As limita&#231;&#245;es deste estudo s&#227;o inerentes ao seu desenho retrospetivo&#44; o que faz com que as associa&#231;&#245;es encontradas possam n&#227;o ter necessariamente um nexo de causalidade&#46; Por outro lado&#44; os OR calculados representam apenas uma aproxima&#231;&#227;o do real risco relativo &#8211; que apenas poder&#225; ser calculado com metodologias prospetivas&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">&#201; por isto vital o estudo prospetivo dos fatores de risco potencialmente revers&#237;veis da insufici&#234;ncia renal no p&#243;s&#8208;operat&#243;rio card&#237;aco&#44; de forma a ser vi&#225;vel uma avalia&#231;&#227;o mais precisa do risco e da causalidade para as vari&#225;veis independentes consideradas&#46; Por outro lado&#44; o facto de o estudo ser monoc&#234;ntrico condiciona a inclus&#227;o de um n&#250;mero reduzido de doentes&#44; nomeadamente de rec&#233;m&#8208;nascidos&#44; o grupo mais suscet&#237;vel ao desenvolvimento de les&#227;o renal no p&#243;s&#8208;operat&#243;rio card&#237;aco&#46; Tal refor&#231;a a import&#226;ncia do desenho de metodologias multic&#234;ntricas no estudo desta patologia&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conclus&#227;o</span><p id="par0290" class="elsevierStylePara elsevierViewall">No p&#243;s&#8208;operat&#243;rio card&#237;aco a insufici&#234;ncia renal &#233; comum e determina um mau progn&#243;stico&#44; com aumento significativo do tempo de internamento&#44; ventila&#231;&#227;o mec&#226;nica invasiva e mortalidade&#46; A idade mais jovem e a eleva&#231;&#227;o precoce da creatinina&#44; ureia e lactatos s&#233;ricos foram preditores robustos da ocorr&#234;ncia de insufici&#234;ncia renal nesta popula&#231;&#227;o&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Responsabilidades &#233;ticas</span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Prote&#231;&#227;o de pessoas e animais</span><p id="par0295" class="elsevierStylePara elsevierViewall">Os autores declaram que para esta investiga&#231;&#227;o n&#227;o se realizaram experi&#234;ncias em seres humanos e&#47;ou animais&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Confidencialidade dos dados</span><p id="par0300" class="elsevierStylePara elsevierViewall">Os autores declaram ter seguido os protocolos do seu centro de trabalho acerca da publica&#231;&#227;o dos dados de pacientes&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Direito &#224; privacidade e consentimento escrito</span><p id="par0305" class="elsevierStylePara elsevierViewall">Os autores declaram que n&#227;o aparecem dados de pacientes neste artigo&#46;</p></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflito de interesses</span><p id="par0310" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o e objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Caracterizar&#44; no nosso centro&#44; a epidemiologia&#44; fatores de risco e impacto progn&#243;stico da insufici&#234;ncia renal aguda no p&#243;s&#8208;operat&#243;rio card&#237;aco&#46; Desenvolver um modelo de regress&#227;o log&#237;stica para estimativa do risco de insufici&#234;ncia renal aguda na popula&#231;&#227;o em estudo&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudo retrospetivo e monoc&#234;ntrico em que foram inclu&#237;dos doentes pedi&#225;tricos consecutivos com cardiopatia cong&#233;nita&#44; submetidos a cirurgia card&#237;aca entre janeiro de 2010 e dezembro de 2012&#46; Foram exclu&#237;dos aqueles com doen&#231;a renal pr&#233;via&#44; hist&#243;ria de di&#225;lise ou transplanta&#231;&#227;o renal&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 325 doentes&#44; idade mediana<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3 anos &#40;um dia&#59; 18 anos&#41;&#46; Quarenta &#40;12&#44;3&#37;&#41; doentes desenvolveram insufici&#234;ncia renal aguda no primeiro dia ap&#243;s a cirurgia&#46; Nove &#40;69&#37;&#41; dos 13 doentes falecidos no p&#243;s&#8208;operat&#243;rio integravam o grupo com insufici&#234;ncia renal&#46; A ocorr&#234;ncia de insufici&#234;ncia renal aguda condicionou um aumento do tempo de internamento na unidade de cuidados intensivos&#44; da dura&#231;&#227;o da ventila&#231;&#227;o mec&#226;nica invasiva e da mortalidade intra&#8208;hospitalar &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Foi constru&#237;do um modelo de regress&#227;o log&#237;stica &#40;vari&#225;vel dependente&#58; insufici&#234;ncia renal aguda p&#243;s&#8208;operat&#243;ria&#44; vari&#225;veis preditoras&#58; idade e valores s&#233;ricos de creatinina&#44; ureia e lactatos registados no primeiro dia de p&#243;s&#8208;operat&#243;rio&#41;&#46; O modelo previu de forma significativa a ocorr&#234;ncia de insufici&#234;ncia renal aguda p&#243;s&#8208;operat&#243;ria nesta popula&#231;&#227;o&#44; com uma sensibilidade e especificidade m&#225;ximas combinadas de 82&#44;1 e 75&#44;4&#37;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">No p&#243;s&#8208;operat&#243;rio card&#237;aco a insufici&#234;ncia renal &#233; comum e determina um mau progn&#243;stico&#46; A idade mais jovem e a eleva&#231;&#227;o precoce da creatinina&#44; ureia e lactatos s&#233;ricos foram preditores robustos da ocorr&#234;ncia de insufici&#234;ncia renal nesta popula&#231;&#227;o&#44; permitindo a constru&#231;&#227;o de um modelo anal&#237;tico objetivo que poder&#225; ser &#250;til na estratifica&#231;&#227;o de risco nestes doentes&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To characterize the epidemiology and risk factors for acute kidney injury &#40;AKI&#41; after pediatric cardiac surgery in our center&#44; to determine its association with poor short&#8208;term outcomes&#44; and to develop a logistic regression model that will predict the risk of AKI for the study population&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">This single&#8208;center&#44; retrospective study included consecutive pediatric patients with congenital heart disease who underwent cardiac surgery between January 2010 and December 2012&#46; Exclusion criteria were a history of renal disease&#44; dialysis or renal transplantation&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Of the 325 patients included&#44; median age three years &#40;1 day&#8208;18 years&#41;&#44; AKI occurred in 40 &#40;12&#46;3&#37;&#41; on the first postoperative day&#46; Overall mortality was 13 &#40;4&#37;&#41;&#44; nine of whom were in the AKI group&#46; AKI was significantly associated with length of intensive care unit stay&#44; length of mechanical ventilation and in&#8208;hospital death &#40;p&#60;0&#46;01&#41;&#46; Patients&#8217; age and postoperative serum creatinine&#44; blood urea nitrogen and lactate levels were included in the logistic regression model as predictor variables&#46; The model accurately predicted AKI in this population&#44; with a maximum combined sensitivity of 82&#46;1&#37; and specificity of 75&#46;4&#37;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">AKI is common and is associated with poor short&#8208;term outcomes in this setting&#46; Younger age and higher postoperative serum creatinine&#44; blood urea nitrogen and lactate levels were powerful predictors of renal injury in this population&#46; The proposed model could be a useful tool for risk stratification of these patients&#46;</p></span>"
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Curva ROC para o modelo de regress&#227;o log&#237;stica proposto&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CC&#58; cardiopatia congenital&#59; IRA&#58; insufici&#234;ncia renal aguda&#59; TFG&#58; taxa de filtra&#231;&#227;o glomerular&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sem IRA&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>285&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Idade &#224; cirurgia &#40;anos&#41;</span><span class="elsevierStyleItalic">Mediana &#40;intervalo interquartis&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;2 &#40;14&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sexo masculino&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">154 &#40;88&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;11&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sexo feminino&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131 &#40;86&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;13&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Peso &#40;kg&#41;</span><span class="elsevierStyleItalic">Mediana &#40;intervalo interquartis&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#44;8 &#40;74&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;2 &#40;57&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CC cian&#243;tica&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;80&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;19&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Creatinina s&#233;rica pr&#233;&#8208;operat&#243;ria &#40;mg&#47;dL&#41;</span><span class="elsevierStyleItalic">M&#233;dia</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">desvio padr&#227;o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Ureia s&#233;rica pr&#233;&#8208;operat&#243;ria &#40;mg&#47;dL&#41;</span><span class="elsevierStyleItalic">M&#233;dia</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">desvio padr&#227;o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">TFG pr&#233;&#8208;operat&#243;ria &#40;ml&#47;min&#47;1&#44;73</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">m</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleItalic">&#41;</span><span class="elsevierStyleItalic">M&#233;dia</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">desvio padr&#227;o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">117&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>38&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">151&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>104&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Score</span> complexidade cir&#250;rgica&#44; n &#40;&#37;&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">151 &#40;88&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;11&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69 &#40;81&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;18&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tempo de bypass cardiopulmonar &#40;min&#41;</span><span class="elsevierStyleItalic">M&#233;dia</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">desvio padr&#227;o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tempo de clampagem a&#243;rtica &#40;min&#41;</span><span class="elsevierStyleItalic">M&#233;dia</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">desvio padr&#227;o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Score</span> inotr&#243;pico&#44; n &#40;&#37;&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Alto &#40;&#8805;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">8&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;28&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Baixo &#40;&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">8&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">225 &#40;93&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;6&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Vari&#225;veis preditoras&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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            0 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Birth prevalence of congenital heart disease worldwide&#58; a systematic review and meta&#8208;analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Van der Linde"
                            1 => "E&#46;E&#46;M&#46; Konings"
                            2 => "M&#46;A&#46; Slager"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2011.08.025"
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                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2011"
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                        "paginaInicial" => "2241"
                        "paginaFinal" => "2247"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22078432"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0065"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Incidence&#44; risk factors&#44; and outcomes of acute kidney injury after pediatric cardiac surgery&#58; a prospective multicenter study"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                          ]
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                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e31821201d3"
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                        "tituloSerie" => "Crit Care Med&#46;"
                        "fecha" => "2011"
                        "volumen" => "39"
                        "paginaInicial" => "1493"
                        "paginaFinal" => "1499"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21336114"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                ]
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              "identificador" => "bib0070"
              "etiqueta" => "3"
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                    0 => array:2 [
                      "titulo" => "A small post&#8208;operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery"
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                          "autores" => array:3 [
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                            2 => "R&#46;S&#46; Saczkowski"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1038/ki.2009.270"
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                        "tituloSerie" => "Kidney Int&#46;"
                        "fecha" => "2009"
                        "volumen" => "76"
                        "paginaInicial" => "885"
                        "paginaFinal" => "892"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19641482"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                          "autores" => array:3 [
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                            1 => "A&#46; Al Abbas"
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                      ]
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                        "link" => array:1 [
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                      "titulo" => "The Aristotle score&#58; a complexity&#8208;adjusted method to evaluate surgical results"
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