{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T14:41:51Z","timestamp":1780497711358,"version":"3.54.1"},"reference-count":36,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T00:00:00Z","timestamp":1770508800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Cardiac surgery-associated acute kidney injury (CSA-AKI) remains a serious complication. The ratio of the venous-arterial carbon dioxide partial pressure difference (Pv-aCO\n                      <jats:sub>2<\/jats:sub>\n                      ) to the arterial-venous oxygen content difference (Ca-vO\n                      <jats:sub>2<\/jats:sub>\n                      ) is an indicator of tissue perfusion and anaerobic metabolism. We aimed to assess whether peak Pv-aCO\n                      <jats:sub>2<\/jats:sub>\n                      \/Ca-vO\n                      <jats:sub>2<\/jats:sub>\n                      during cardiopulmonary bypass (CPB) predicts CSA-AKI in pediatric patients with cyanotic congenital heart disease (CHD).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively reviewed patients aged &lt; 10 years with cyanotic CHD who underwent cardiac surgery with CPB between January 2019 and August 2024. Peak Pv-aCO\n                      <jats:sub>2<\/jats:sub>\n                      \/Ca-vO\n                      <jats:sub>2<\/jats:sub>\n                      during CPB was analyzed for its association with CSA-AKI using multivariate logistic regression adjusted for age, weight, CPB duration, aortic cross-clamp (ACC) time, and red blood cell transfusion. Classification and regression tree (CART) analysis was conducted to develop a predictive model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This study included 191 patients (96 (50.3 %) males; median age: 196 days [interquartile range (IQR), 55\u2013474]). CSA-AKI occurred in 65 patients (34.0 %). Peak Pv-aCO\n                      <jats:sub>2<\/jats:sub>\n                      \/Ca-vO\n                      <jats:sub>2<\/jats:sub>\n                      was higher in the AKI group than in the non-AKI group (IQR, 4.8 [3.9\u20137.5] vs 3.9 [2.8\u20135.4] mmHg\u00b7dL\/mL;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.001) and was significantly associated with CSA-AKI (adjusted odds ratio: 1.14; 95% confidence interval: 1.04\u20131.27). A CART-derived predictive model included ACC time, peak Pv-aCO\n                      <jats:sub>2<\/jats:sub>\n                      \/Ca-vO\n                      <jats:sub>2<\/jats:sub>\n                      , and weight. A Pv-aCO\n                      <jats:sub>2<\/jats:sub>\n                      \/Ca-vO\n                      <jats:sub>2<\/jats:sub>\n                      cut-off of 4.0 mmHg\u00b7dL\/mL yielded 36.9 % sensitivity, 96.0 % specificity, 82.8 % positive predictive value, and 75.9 % negative predictive value.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      In pediatric cardiac surgery for cyanotic CHD, high Pv-aCO\n                      <jats:sub>2<\/jats:sub>\n                      \/Ca-vO\n                      <jats:sub>2<\/jats:sub>\n                      predicts CSA-AKI. These findings highlight the potential role of Pv-aCO\n                      <jats:sub>2<\/jats:sub>\n                      \/Ca-vO\n                      <jats:sub>2<\/jats:sub>\n                      monitoring during CPB in developing novel pediatric goal-directed perfusion strategies.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591261424366","type":"journal-article","created":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T14:14:14Z","timestamp":1770560054000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Prediction of cardiac surgery-associated acute kidney injury in cyanotic congenital heart disease"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0031-1220","authenticated-orcid":false,"given":"Kazuki","family":"Fujishiro","sequence":"first","affiliation":[{"name":"The University of Tokyo 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