New Insights in Assessing AKI 3 Risk Factors and Predictors Associated with On-Pump Surgical Aortic Valve Replacement

<b>Background</b>: Acute kidney injury (AKI) following cardiac surgery can lead to chronic kidney disease, increased hospitalization costs, and higher mortality risk. Our retrospective study identified risk factors of severe AKI (AKI 3) in patients undergoing on-pump surgical aortic valve replacement (SAVR). Additionally, we analyzed the significance of inflammatory indexes and risk scores in predicting AKI 3, focusing on sex differences. These findings could provide cost-efficient tools for clinical practice to identify patients at risk, improve preoperative risk stratification, and personalize monitoring. <b>Methods</b>: We reviewed the on-pump SAVR patients from our tertiary center between 2022 and 2024. <b>Results</b>: Out of 422 patients, 121 (28.67%) experienced AKI, including 27 (6.39%) AKI 3 patients. The multivariable binary logistic regression identified AKI 3 independent risk factors: hemostasis reintervention (OR9.76, CI 95%: 3.565-26.716, <i>p</i> = 0.001), early postoperative vasoactive-inotropic score (VIS) (OR1.049, CI 95%: 1.013-1.086, <i>p</i> = 0.007), postoperative lymphocyte (OR2.252, CI 95%: 1.224-4.144, <i>p</i> = 0.009). Preoperative systemic inflammatory response index (AUC0.700, <i>p</i> = 0.019), preoperative aggregate index of systemic inflammation (AUC0.712, <i>p</i> = 0.011), postoperative platelet-to-lymphocyte ratio (PLR) (AUC 0.759, <i>p</i> = 0.001), and the delta value of preoperative-to-postoperative PLR (AUC0.752, <i>p</i> = 0.001) were better predictors of AKI 3 occurrence in female SAVR patients than the additive EuroSCORE (AUC0.692, <i>p</i> = 0.011), but were less accurate compared to EuroSCORE II (AUC0.841, <i>p</i> = 0.001). None of the studied inflammatory indexes or additive EuroSCORE predicted our endpoint in male SAVR patients, while Thakar score was able to predict it exclusively in males. <b>Conclusions</b>: Early postoperative VIS, lymphocyte count, and hemostasis reintervention were independent risk factors for severe AKI in SAVR patients. There is a differentiation between males and females from the AKI prediction perspective.