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Varela, Aline Macedo Pinheiro, Paula Castro Scherer, Rossana P.V. Francisco, Marcelo Luis Abramides Torres, Maria José C. Carmona, Fernando Bliacheriene, Lúcia C. Andrade, Paolo Pelosi, Luiz Marcelo S. Malbouisson" "autores" => array:11 [ 0 => array:4 [ "nombre" => "Wallace Andrino da" "apellidos" => "Silva" "email" => array:1 [ 0 => "wallaceandrino@yahoo.com.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Carlo Victor A." "apellidos" => "Varela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "Aline Macedo" "apellidos" => "Pinheiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "Paula Castro" "apellidos" => "Scherer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] ] ] 4 => array:3 [ "nombre" => "Rossana P.V." "apellidos" => "Francisco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">II</span>" "identificador" => "aff2" ] ] ] 5 => array:3 [ "nombre" => "Marcelo Luis Abramides" "apellidos" => "Torres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] ] ] 6 => array:3 [ "nombre" => "Maria José C." "apellidos" => "Carmona" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] ] ] 7 => array:3 [ "nombre" => "Fernando" "apellidos" => "Bliacheriene" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] ] ] 8 => array:3 [ "nombre" => "Lúcia C." "apellidos" => "Andrade" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">III</span>" "identificador" => "aff3" ] ] ] 9 => array:3 [ "nombre" => "Paolo" "apellidos" => "Pelosi" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">IV</span>" "identificador" => "aff4" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">V</span>" "identificador" => "aff5" ] ] ] 10 => array:3 [ "nombre" => "Luiz Marcelo S." "apellidos" => "Malbouisson" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Departamento de Anestesia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR" "etiqueta" => "I" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR" "etiqueta" => "II" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Departamento de Nefrologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR" "etiqueta" => "III" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Universitè degli Studi di Genova, Genoa, Italy" "etiqueta" => "IV" "identificador" => "aff4" ] 4 => array:3 [ "entidad" => "IRCCS Ospedale Policlinico San Martino, Genoa, Italy" "etiqueta" => "V" "identificador" => "aff5" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1812 "Ancho" => 1708 "Tamanyo" => 205098 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Flow chart of the study design.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Preeclampsia is a multifactorial syndrome, clinically characterized by hypertension and proteinuria after 20 weeks of pregnancy. It occurs in 3–14% of pregnancies and is responsible for 60,000 maternal deaths worldwide each year. In patients with severe preeclampsia, the risk of pulmonary edema, coagulopathy, hemorrhage, and acute kidney injury (AKI) is higher (<a class="elsevierStyleCrossRef" href="#bib1">1</a>). Since 2013, proteinuria is not an essential criteria for the diagnosis of preeclampsia, if any of these severe features are presented: thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, and cerebral or visual symptoms (<a class="elsevierStyleCrossRef" href="#bib2">2</a>).</p><p id="para20" class="elsevierStylePara elsevierViewall">In developed countries, the incidence of AKI has increased in the latest decades, especially among women with preeclampsia (<a class="elsevierStyleCrossRef" href="#bib3">3</a>). In Canada, the incidence of AKI during pregnancy increased significantly from 1.66 to 2.68 per 10,000 deliveries between 2002 and 2010 (<a class="elsevierStyleCrossRef" href="#bib3">3</a>), whereas it increased from 2.3 to 4.5 per 10,000 deliveries between 1998 and 2008 in the United States (<a class="elsevierStyleCrossRef" href="#bib4">4</a>). In patients with severe preeclampsia undergoing cesarean section, the incidence of AKI has been reported up to 60%, but varying according to the type of patients, definition of AKI, and intraoperative management (<a class="elsevierStyleCrossRef" href="#bib5">5</a>).</p><p id="para30" class="elsevierStylePara elsevierViewall">Fluid management in severe preeclampsia is controversial, especially fluid replacement during cesarean section. In severe preeclampsia, increased pulmonary capillary permeability and increased left ventricular end-diastolic pressure can lead to acute pulmonary edema even after intravenous volume replacement (<a class="elsevierStyleCrossRef" href="#bib6">6</a>). Therefore, fluid restriction might prevent pulmonary edema (<a class="elsevierStyleCrossRef" href="#bib3">3</a>,<a class="elsevierStyleCrossRef" href="#bib4">4</a>,<a class="elsevierStyleCrossRef" href="#bib7">7</a>). On the other hand, hypovolemia associated with fluid restriction can induce renal hypoperfusion and exacerbate AKI (<a class="elsevierStyleCrossRef" href="#bib3">3</a>).</p><p id="para40" class="elsevierStylePara elsevierViewall">Although creatinine is a traditional marker of kidney function, serum creatinine increases only after ≥50% of renal function has been lost (<a class="elsevierStyleCrossRef" href="#bib8">8</a>). In preeclampsia, early biomarkers of kidney injury have been studied to enable rapid diagnosis and early treatment for the preservation of kidney function (<a class="elsevierStyleCrossRefs" href="#bib9">9–11</a>). Cystatin C is a low-molecular-weight protein secreted by nucleated cells, freely filtered by the glomeruli, and completely reabsorbed/metabolized by the proximal tubules (<a class="elsevierStyleCrossRef" href="#bib12">12</a>). Neutrophil gelatinase-associated lipocalin (NGAL) accumulates in blood within the first 3 hours after renal injury and remains elevated for several days after the initial insult (<a class="elsevierStyleCrossRef" href="#bib13">13</a>).</p><p id="para50" class="elsevierStylePara elsevierViewall">Since the most effective intravenous fluid regimen is unclear, we conducted the present pilot trial to compare a restrictive fluid regimen with a more traditional (liberal) regimen in patients with severe preeclampsia during cesarean section surgery. Our primary hypothesis was that a restrictive fluid regimen would lead to a higher rate of postoperative AKI than a liberal fluid regimen in patients with severe preeclampsia who underwent cesarean section.</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">MATERIALS AND METHODS</span><p id="para60" class="elsevierStylePara elsevierViewall">We performed a prospective randomized clinical trial. We evaluated all patients with severe preeclampsia admitted to the Obstetrics Department of the University of São Paulo School Of Medicine, Hospital das Clínicas with an indication for cesarean section between July 2014 and September 2015. The study was registered in the ClinicalTrials.gov database (identifier: NCT02214186; July 8, 2014) and was approved by the Hospital das Clínicas Committee for the Analysis of Research Projects (Ruling no. 01945012.6.0000.0068).</p><p id="para70" class="elsevierStylePara elsevierViewall">We included patients with severe preeclampsia undergoing cesarean section under spinal anesthesia. Patients were classified as having severe preeclampsia if they met at least one of the following criteria: systolic pressure at rest ≥160 mmHg or diastolic pressure at rest ≥110 mmHg on two occasions at least 4 hours apart (unless antihypertensive therapy was previously initiated); thrombocytopenia (platelet count <100 cells × 10<span class="elsevierStyleSup">3</span>/mm<span class="elsevierStyleSup">3</span>); impaired liver function (serum transaminases at least twice the normal concentration); severe persistent right upper quadrant or epigastric pain unresponsive to medication and not attributable to alternative diagnoses; pulmonary edema; and new-onset cerebral or visual disturbances. Although renal insufficiency is now considered a criterion of severity by the American College of Obstetricians and Gynecologists (<a class="elsevierStyleCrossRef" href="#bib2">2</a>), it was not considered in this study because the occurrence of AKI was the primary outcome. Patients with a preoperative serum creatinine level >1.0 mg/dl were excluded, as were those with a history of renal disease, those undergoing another surgical procedure simultaneously, those receiving anesthesia other than spinal anesthesia, and those in whom labor had previously been induced. Beside this, those who did not accept to participate in the research and did not sign the informed consent form were excluded.</p><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">Randomization and Intervention</span><p id="para80" class="elsevierStylePara elsevierViewall">All eligible patients were included in the randomization procedure. Allocation numbers were derived from a random number table and placed in envelopes that were opened only by the anesthesiologist who performed the spinal anesthesia. Patients were randomly allocated to a restrictive (250 ml of lactated Ringer's) or liberal (1500 ml of lactated Ringer's) fluid regimen during cesarean section. Informed consent was obtained immediately before the cesarean section.</p><p id="para90" class="elsevierStylePara elsevierViewall">To avoid any interference with the renal function, the use of nonsteroidal anti-inflammatory drugs and omeprazole was prohibited during hospitalization. Intraoperatively, patients received metaraminol (200 µg, intravenously) if their systolic blood pressure dropped by >20% in relation to the baseline value, with a subsequent bolus if the hypotension persisted or hydralazine (5 mg, intravenously) every 15 minutes if their blood pressure was >180/110 mmHg. Spinal anesthesia was performed in accordance with the institutional protocol—0.5% hyperbaric bupivacaine (15 mg), fentanyl (10 µg), and morphine (100 µg). No preloading was performed before spinal anesthesia. Postoperatively, all of the patients received an infusion of 10 units of oxytocin diluted in 500 ml of 5% dextrose over a 6-hour period, also in accordance with the institutional protocol, together with intramuscular administration of magnesium sulfate, as in the Pritchard regimen. None of the patients required additional maintenance of crystalloid infusion, but only the amount needed for drugs administration. Unrestricted diet and water ingestion were allowed for all patients 8 hours after cesarean section.</p></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">Outcome Measures</span><p id="para100" class="elsevierStylePara elsevierViewall">The primary outcome measure was the change in serum creatinine on the first and second postoperative days compared to the preoperative values (baseline), used as a proxy for renal function. Using the modified Acute Kidney Injury Network (AKIN) classification (<a class="elsevierStyleCrossRef" href="#bib14">14</a>), we stratified renal dysfunction into three categories, on the basis of the increase in serum creatinine over the preoperative value: stage 1 (150-200%), stage 2 (200-300%), and stage 3 (>300%). Patients requiring hemodialysis were also categorized as AKIN stage 3.</p><p id="para110" class="elsevierStylePara elsevierViewall">The secondary outcome measures were the serum levels of cystatin C and NGAL, proteinuria, platelet count, and intraoperative urine output.</p><p id="para120" class="elsevierStylePara elsevierViewall">The glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease (MDRD) formula (<a class="elsevierStyleCrossRef" href="#bib15">15</a>), as well as by a formula based on serum cystatin C and serum creatinine (<a class="elsevierStyleCrossRef" href="#bib16">16</a>).</p><p id="para130" class="elsevierStylePara elsevierViewall">All these variables were measured at three time points: preoperative (baseline), on postoperative day 1 (PO1), and on postoperative day 2 (PO2). The variables were compared between the PO1 and baseline, PO2 and PO1, and then the PO2 and baseline.</p><p id="para140" class="elsevierStylePara elsevierViewall">Other intraoperative and postoperative variables that were not previously defined as secondary outcomes were presented as post-hoc analysis in the Appendix section. They were the intensive care unit (ICU) admission, vasopressor use, vasodilator use, supplemental oxygen use (oxygen saturation <94%), length of hospital stay, and umbilical cord blood gases from venous blood (pH, bicarbonate, and base excess), together with the 1- and 5-minute Apgar scores.</p></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">Blinding and Data Quality</span><p id="para150" class="elsevierStylePara elsevierViewall">The attending anesthesiologists who conducted the cesarean section and the early postoperative care had knowledge of the group assignments, but were not included in the present research group. One of researchers staff followed the intraoperative and postoperative period to ensure that there was no breach in the study protocol. The research investigator responsible for analysing the outcome was blinded to the group assignment.</p></span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle110">Statistical Analysis</span><p id="para160" class="elsevierStylePara elsevierViewall">All the analyses were performed in a modified intention-to-treat population, which included all randomized patients with severe preeclampsia undergoing to cesarean section. All the patients were followed-up from the cesarean section until the hospital discharge.</p><p id="para170" class="elsevierStylePara elsevierViewall">The sample size selected was based on previously published studies. A recent population-based study performed by Mehrabadi et al. showed that hypertensive disorders were presented in 65.9% of the cases of obstetric acute renal failure (<a class="elsevierStyleCrossRef" href="#bib3">3</a>). Huang et al. demonstrated that 60% of women with HELLP syndrome were complicated with AKI (<a class="elsevierStyleCrossRef" href="#bib5">5</a>). Further, previous observations in our center suggested an AKI incidence of 60 to 80% in patients with severe features of preeclampsia. We must point out that variable incidence of postoperative AKI has been reported in the literature. This variation is due to the different types of patients enrolled (chronic hypertension, preeclampsia, severe preeclampsia, HELP syndrome, and eclampsia), methods to define AKI, and intraoperative management strategies among the different studies. Thus, assuming a power of 80% and a 95% confidence interval, the minimum sample necessary to conduct the study was calculated to be 46 patients (23 in each group of interest).</p><p id="para180" class="elsevierStylePara elsevierViewall">Quantitative variables were evaluated for normality with the Kolmogorov-Smirnov test. Variables with normal distribution were described as means and standard deviations, being compared by repeated-measures analysis of variance. Variables without normal distribution were described as medians and interquartile ranges, being compared by the nonparametric Kruskal-Wallis and Friedman tests. The Mann-Whitney test and Student's <span class="elsevierStyleItalic">t</span>-test were used in comparisons of independent samples. Qualitative variables were described as absolute and relative frequencies, the chi-square test or Fisher's exact test being used in determining associations. Values of <span class="elsevierStyleItalic">p</span>≤0.05 were considered significant. Statistical analyses were performed using the Statistical Package for the Social Sciences version 18.0 (SPSS Inc., Chicago, IL, USA).</p></span></span><span id="cesec70" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle120">RESULTS</span><p id="para190" class="elsevierStylePara elsevierViewall">Of 110 eligible patients with preeclampsia, 46 met the inclusion criteria and were enrolled in the study, 23 being allocated to the intravenous liberal regimen and 23 to the intravenous restrictive regimen. After allocation, four patients (two from each group) dropped out, although they remained in the final (intention-to-treat) analyses (<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>). The baseline characteristics were similar between the two groups (<a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>).</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><elsevierMultimedia ident="tbl1"></elsevierMultimedia><p id="para200" class="elsevierStylePara elsevierViewall">Intraoperative fluid administration, urine output, and cumulative fluid administration during the first eight postoperative hours are shown in <a class="elsevierStyleCrossRef" href="#tbl2">Table 2</a>.</p><elsevierMultimedia ident="tbl2"></elsevierMultimedia><span id="cesec80" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle130">Primary outcome</span><p id="para210" class="elsevierStylePara elsevierViewall">The rate of postoperative AKI was 43.5% in the liberal fluid group and 43.5% in the restrictive fluid group (<span class="elsevierStyleItalic">p</span>=1.0). AKIN graduation (stage 1, 2 and 3) had no statistical difference (<a class="elsevierStyleCrossRef" href="#tbl3">Table 3</a>).</p><elsevierMultimedia ident="tbl3"></elsevierMultimedia><p id="para220" class="elsevierStylePara elsevierViewall">Serum creatinine was significantly higher on PO1 and PO2 than at baseline in both groups (<span class="elsevierStyleItalic">p</span><0.05). In the restrictive group, serum creatinine was lower on PO2 than on PO1 (<span class="elsevierStyleItalic">p</span><0.05).</p></span><span id="cesec90" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle140">Secondary outcomes</span><p id="para230" class="elsevierStylePara elsevierViewall">In both groups, cystatin C was significantly lower on PO2 than on PO1 (<span class="elsevierStyleItalic">p</span><0.05). In the restrictive group, the level of NGAL was significantly higher on PO1 than at baseline (<span class="elsevierStyleItalic">p</span><0.05), although it was significantly lower on PO2 than on PO1 (<span class="elsevierStyleItalic">p</span><0.05). There was no significant change in NGAL in the liberal group.</p><p id="para240" class="elsevierStylePara elsevierViewall">In both groups, the MDRD-estimated GFR was significantly lower on PO1 and PO2 than at baseline (<span class="elsevierStyleItalic">p</span><0.05), whereas the creatinine/cystatin C-estimated GFR was significantly lower on PO1 than at baseline (<span class="elsevierStyleItalic">p</span><0.05) and significantly higher on PO2 than on PO1 (<span class="elsevierStyleItalic">p</span><0.05).</p><p id="para250" class="elsevierStylePara elsevierViewall">On PO1 and PO2, proteinuria was significantly lower in comparison to the baseline value in both groups (<span class="elsevierStyleItalic">p</span><0.05). The platelet count was significantly higher on PO2 compared to PO1 in both groups (<span class="elsevierStyleItalic">p</span><0.05).</p></span><span id="cesec100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle150">Post-hoc analysis</span><p id="para260" class="elsevierStylePara elsevierViewall">The dose of metaraminol required in the intraoperative period was significantly higher in the restrictive group. The median dose of metaraminol used in the restrictive group was 1.2 (0.9-2.2) mg <span class="elsevierStyleItalic">versus</span> 0.8 (0.6-1.4) mg in the liberal group (<span class="elsevierStyleItalic">p</span>=0.039).</p><p id="para270" class="elsevierStylePara elsevierViewall">The two groups did not differ in terms of the use of vasodilators, hemodialysis requirement, need for supplemental oxygen, ICU admission rate, length of hospital stay, neonatal Apgar scores, or the results of the analysis of umbilical cord blood gases (Table S1).</p></span></span><span id="cesec110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle160">DISCUSSION</span><p id="para280" class="elsevierStylePara elsevierViewall">In this monocentric randomized controlled pilot trial including patients with severe preeclampsia, a restrictive fluid regimen during cesarean section was not associated with increased postoperative AKI.</p><p id="para290" class="elsevierStylePara elsevierViewall">Intravenous fluid therapy during and after surgery restores and maintains body water, electrolytes, and organ perfusion to achieve homeostasis (<a class="elsevierStyleCrossRef" href="#bib17">17</a>). The optimal fluid regimen in patients during cesarian section and preeclampsia is under debate (<a class="elsevierStyleCrossRef" href="#bib18">18</a>). To our knowledge, this is the first randomized controlled trial evaluating the effects of liberal or restrictive fluid regimen during surgery on postoperative AKI in patients with severe eclampsia.</p><p id="para300" class="elsevierStylePara elsevierViewall">Recent clinical practice guidelines for preeclampsia recommend restricting fluid administration to ≤80 ml/h in the peripartum period to prevent pulmonary edema and other complications of fluid overload (<a class="elsevierStyleCrossRef" href="#bib19">19</a>,<a class="elsevierStyleCrossRef" href="#bib20">20</a>). In the United Kingdom Amniotic Fluid Embolism Register, the recommended urine output tolerance is 20 ml/h in the first 8 hours after delivery (<a class="elsevierStyleCrossRef" href="#bib19">19</a>). In the pregnancy hypertension guidelines employed in British Columbia, the implementation of a new restrictive protocol was reported to have no effect on the relative risk of developing AKI (<a class="elsevierStyleCrossRef" href="#bib20">20</a>).</p><p id="para310" class="elsevierStylePara elsevierViewall">In our study, the definition of the amount of volume administered in the restrictive group was based on experience of intraoperative hydration in pregnant women with severe heart disease, in whom aliquots of 250 mL to 300 mL of crystalloid solution were well tolerated and without repercussions (<a class="elsevierStyleCrossRef" href="#bib21">21</a>,<a class="elsevierStyleCrossRef" href="#bib22">22</a>). The amount administered in the liberal group was based on the institutional routine. This quantitative of fluids was considered safe since it was smaller than the volume found by Thornton et al. in a study that evaluated the amount of intrapartum fluids and the occurrence of acute edema in pregnancy (<a class="elsevierStyleCrossRef" href="#bib23">23</a>).</p><p id="para320" class="elsevierStylePara elsevierViewall">Critical patients in intensive care unit submitted to restrictive fluid regimes have not been associated with worsening of their renal function (<a class="elsevierStyleCrossRefs" href="#bib24">24–26</a>). In a randomized trial comparing a liberal and a conservative strategy of fluid management in acute lung injury, the lung function was improved and the duration of mechanical ventilation and intensive care stay was reduced by the conservative strategy. The conservative strategy did not increase non pulmonary-organ failures, such as renal function (<a class="elsevierStyleCrossRef" href="#bib24">24</a>).</p><p id="para330" class="elsevierStylePara elsevierViewall">Fluid overload can have an adverse effect on encapsulated organs, such as the kidneys, because it increases venous pressure and promotes interstitial edema, thus having a direct impact on kidney function (<a class="elsevierStyleCrossRef" href="#bib27">27</a>,<a class="elsevierStyleCrossRef" href="#bib28">28</a>). In addition, excessive fluid resuscitation is a risk factor for the development of abdominal hypertension and abdominal compartment syndrome, which can further impair renal perfusion (<a class="elsevierStyleCrossRef" href="#bib29">29</a>). The development of fluid overload can complicate the diagnosis of AKI when that diagnosis is based on a change in serum creatinine. Serum creatinine is known to distribute into the intracellular and extracellular fluid compartments (<a class="elsevierStyleCrossRef" href="#bib30">30</a>).</p><p id="para340" class="elsevierStylePara elsevierViewall">Despite the previous publications about the benefits of restrictive therapies, a recent trial with patients undergoing major abdominal surgery (Relief Trial) showed that restrictive compared to liberal fluid regimen was associated with increased AKI (<a class="elsevierStyleCrossRef" href="#bib31">31</a>). An important data is that colloids were administrated during the perioperative period in more patients from the restrictive group than the liberal group in Relief Trial (<a class="elsevierStyleCrossRef" href="#bib31">31</a>).</p><p id="para350" class="elsevierStylePara elsevierViewall">In the present study, patients in both groups showed a worsening in serum creatinine and the MDRD-estimated GFR on postoperative days, without a return to baseline. This finding suggests that the patients are still at risk for postoperative AKI even after delivery. Further, differently from previous studies (<a class="elsevierStyleCrossRef" href="#bib24">24</a>,<a class="elsevierStyleCrossRef" href="#bib31">31</a>), we defined <span class="elsevierStyleItalic">a priori</span> acute kidney injury using recent proposed scores and additionally, renal biomarkers have been evaluated before and after surgery. Cystatin C was significantly lower on second postoperative days suggesting an improvement in renal function in both groups. The recovery of renal function was evidenced by the fact that the creatinine/cystatin C-estimated GFR was decreased on the first postoperative day, but recovered on the second postoperative day in both groups. Our assessment of NGAL in the restrictive group indicated worsening of renal function in the immediate postoperative period, followed by improvement on the second postoperative day. A combined evaluation of these new biomarkers of renal injury suggested that the renal function of severe preeclampsia patients worsens on the first day after cesarean section, improving (returning to preoperative values) by the second day. Knowing that creatinine is a late marker, it cannot detect an improvement in renal function. A reduction in proteinuria, which is also indicative of recovery from renal injury was seen in both groups.</p><p id="para360" class="elsevierStylePara elsevierViewall">Cystatin C has been proposed as an alternative marker for estimating the GFR in native kidney disease (<a class="elsevierStyleCrossRef" href="#bib16">16</a>,<a class="elsevierStyleCrossRef" href="#bib32">32</a>). A composite equation based on serum cystatin C, serum creatinine, age, and gender has been shown to be superior to separate creatinine- and cystatin C-based equations (<a class="elsevierStyleCrossRef" href="#bib33">33</a>). The serum concentration of NGAL has been correlated with the presence and severity of preeclampsia in several studies (<a class="elsevierStyleCrossRef" href="#bib10">10</a>,<a class="elsevierStyleCrossRef" href="#bib34">34</a>). The generalized endothelial injury associated with preeclampsia could upregulate circulating NGAL levels.</p><p id="para370" class="elsevierStylePara elsevierViewall">The occurrence of AKI in our study was higher than previous retrospective and observational studies. Huang et al. (<a class="elsevierStyleCrossRef" href="#bib5">5</a>) found 16.8% women with pre-eclampsia/eclampsia and 60% women with HELLP syndrome complicated with AKI. Eswarappa et al. (<a class="elsevierStyleCrossRef" href="#bib35">35</a>) found only 8% of AKIN in a retrospective review of 99 cases of postpartum AKI. However, a population-based study in Canada (<a class="elsevierStyleCrossRef" href="#bib3">3</a>) demonstrated an important increase of AKI among patients with hypertensive disorders (adjusted increase 95%), even higher in women with gestational hypertension having significant proteinuria (adjusted increase 171%). It is important to point out that our study was restricted to a group of severe preeclampsia, which is the main reason for the higher number of AKI cases. Moreover, our study had included patients prospectively and thus did not suffer potential methodological issues related to the retrospective cohort analysis. The other studies evaluated the AKI incidence in the entire population of pregnant women or pregnant women with hypertensive disorders of all types, and not only severe preeclampsia.</p><p id="para380" class="elsevierStylePara elsevierViewall">In the post-hoc analyses, the dose of metaraminol required during cesarean section was higher in the restrictive fluid regimen group. Recent studies indicate that the use of crystalloids is of little or no benefit in counteracting hypotension and reducing the vasopressor dose required during cesarean section (<a class="elsevierStyleCrossRef" href="#bib36">36</a>). Kee et al. found that infusion of 20 ml/kg of lactated Ringer's does not change the total dose of metaraminol used during cesarean section under spinal anesthesia and also does not affect maternal or neonatal outcomes (<a class="elsevierStyleCrossRef" href="#bib37">37</a>).</p><p id="para390" class="elsevierStylePara elsevierViewall">Our study has some limitations to be addressed. First, this is a pilot trial which must be confirmed in larger sample size. Second, urine output was not measured in the postoperative period because the catheter is removed early at our facility according to local guidelines. Therefore, 24-hour urine collection for the calculation of the creatinine clearance to estimate the GFR was not performed. Third, the blood pressure during the entire surgery was not collected, despite the restricted pressure control during cesarean section. Forth, there was no late follow-up of patients to assess the progression of the kidney dysfunction.</p><p id="para400" class="elsevierStylePara elsevierViewall">Despite these limitations, the strength of the paper is that of being the first randomized trial evaluating liberal <span class="elsevierStyleItalic">versus</span> restrictive fluid management in patients with severe preeclampsia and have potential clinical impact.</p></span><span id="cesec120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle170">CONCLUSIONS</span><p id="para410" class="elsevierStylePara elsevierViewall">In patients with severe preeclampsia, a restrictive fluid regimen during cesarean section was not associated with increased postoperative AKI. Additional studies are needed in order to identify the best fluid therapy in this patient population.</p></span><span id="cesec130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle180">AUTHOR CONTRIBUTIONS</span><p id="para420" class="elsevierStylePara elsevierViewall">Silva WA, Varela CVA, Francisco RPV, Torres MLA, Carmona MJC, Bliacheriene F and Malbouisson LMS contributed substantially to the conception, design, and execution of this work. Pinheiro AM and Scherer PC contributed substantially to the acquisition of the data. Andrade LC and Pelosi P analyzed the data and contributed in writing the manuscript. All authors read, contributed to important intellectual content, and approved the final draft of the manuscript prior to submission.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "xpalclavsec1580115" "titulo" => "KEYWORDS" ] 1 => array:2 [ "identificador" => "cesec10" "titulo" => "INTRODUCTION" ] 2 => array:3 [ "identificador" => "cesec20" "titulo" => "MATERIALS AND METHODS" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "cesec30" "titulo" => "Randomization and Intervention" ] 1 => array:2 [ "identificador" => "cesec40" "titulo" => "Outcome Measures" ] 2 => array:2 [ "identificador" => "cesec50" "titulo" => "Blinding and Data Quality" ] 3 => array:2 [ "identificador" => "cesec60" "titulo" => "Statistical Analysis" ] ] ] 3 => array:3 [ "identificador" => "cesec70" "titulo" => "RESULTS" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "cesec80" "titulo" => "Primary outcome" ] 1 => array:2 [ "identificador" => "cesec90" "titulo" => "Secondary outcomes" ] 2 => array:2 [ "identificador" => "cesec100" "titulo" => "Post-hoc analysis" ] ] ] 4 => array:2 [ "identificador" => "cesec110" "titulo" => "DISCUSSION" ] 5 => array:2 [ "identificador" => "cesec120" "titulo" => "CONCLUSIONS" ] 6 => array:2 [ "identificador" => "cesec130" "titulo" => "AUTHOR CONTRIBUTIONS" ] 7 => array:1 [ "titulo" => "REFERENCES" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-02-15" "fechaAceptado" => "2020-05-04" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "KEYWORDS" "identificador" => "xpalclavsec1580115" "palabras" => array:4 [ 0 => "Preeclampsia" 1 => "Acute Kidney Injury" 2 => "Cesarean Section" 3 => "Fluid Therapy" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">OBJECTIVES:</span><p id="spara60" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to determine whether a restrictive compared to a liberal fluid therapy will increase postoperative acute kidney injury (AKI) in patients with severe preeclampsia.</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">METHODS:</span><p id="spara70" class="elsevierStyleSimplePara elsevierViewall">A total of 46 patients (mean age, 32 years; standard deviation, 6.8 years) with severe preeclampsia were randomized to liberal (1500 ml of lactated Ringer's, n=23) or restrictive (250 ml of lactated Ringer's, n=23) intravenous fluid regimen during cesarean section. The primary outcome was the development of a postoperative renal dysfunction defined by AKI Network stage ≥1. Serum cystatin C and neutrophil gelatinase-associated lipocalin (NGAL) were evaluated at postoperative days 1 and 2. ClinicalTrials.gov: NCT02214186.</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">RESULTS:</span><p id="spara80" class="elsevierStyleSimplePara elsevierViewall">The rate of postoperative AKI was 43.5% in the liberal fluid group and 43.5% in the restrictive fluid group (<span class="elsevierStyleItalic">p=</span>1.0). Intraoperative urine output was higher in the liberal (116 ml/h, IQR 69-191) than in the restrictive fluid group (80 ml/h, IQR 37-110, <span class="elsevierStyleItalic">p</span><0.05). In both groups, serum cystatin C did not change from postoperative day 1 compared to the preoperative period and significantly decreased on postoperative day 2 compared to postoperative day 1 (<span class="elsevierStyleItalic">p</span><0.05). In the restrictive fluid group, NGAL levels increased on postoperative day 1 compared to the preoperative period (<span class="elsevierStyleItalic">p</span><0.05) and decreased on postoperative day 2 compared to postoperative day 1 (<span class="elsevierStyleItalic">p</span><0.05).</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">CONCLUSION:</span><p id="spara90" class="elsevierStyleSimplePara elsevierViewall">Among patients with severe preeclampsia, a restrictive fluid regimen during cesarean section was not associated with increased postoperative AKI.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "ceabs10" "titulo" => "OBJECTIVES:" ] 1 => array:2 [ "identificador" => "ceabs20" "titulo" => "METHODS:" ] 2 => array:2 [ "identificador" => "ceabs30" "titulo" => "RESULTS:" ] 3 => array:2 [ "identificador" => "ceabs40" "titulo" => "CONCLUSION:" ] ] ] ] "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara" id="cenpara250">No potential conflict of interest was reported.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:3 [ "apendice" => "<p id="para180a" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tbl4"></elsevierMultimedia></p>" "titulo" => "APPENDIX" "identificador" => "cesec132" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1812 "Ancho" => 1708 "Tamanyo" => 205098 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Flow chart of the study design.</p>" ] ] 1 => array:7 [ "identificador" => "tbl1" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="TFN01t01" class="elsevierStyleSimplePara elsevierViewall">IQR: interquartile range; SD: Standard deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Restrictive Fluid(n=23) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Liberal Fluid(n=23) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"><span class="elsevierStyleItalic">p</span>-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years), mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31±8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.536<a class="elsevierStyleCrossRef" href="#TFN02t01">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Body mass index (kg/m<span class="elsevierStyleSup">2</span>), median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.1 (28.0-33.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.1 (26.9-38.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.325<a class="elsevierStyleCrossRef" href="#TFN03t01">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gestational age (weeks), median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.7 (30.1-37.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.9 (35.3-37.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.581<a class="elsevierStyleCrossRef" href="#TFN03t01">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Twin pregnancy, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (14.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (12.15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0<a class="elsevierStyleCrossRef" href="#TFN04t01">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chronic hypertension, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (39.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (47.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.552<a class="elsevierStyleCrossRef" href="#TFN05t01">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous preeclampsia, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (47.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (39.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.552<a class="elsevierStyleCrossRef" href="#TFN05t01">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnostic criteria for severe preeclampsia, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Persistent high blood pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0<a class="elsevierStyleCrossRef" href="#TFN05t01">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Thrombocytopenia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (4.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0<a class="elsevierStyleCrossRef" href="#TFN05t01">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Impaired liver function \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (4.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0<a class="elsevierStyleCrossRef" href="#TFN05t01">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Right upper quadrant or epigastric pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (17.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.47<a class="elsevierStyleCrossRef" href="#TFN05t01">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pulmonary edema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0<a class="elsevierStyleCrossRef" href="#TFN05t01">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cerebral or visual disturbances \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (39.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (34.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.689<a class="elsevierStyleCrossRef" href="#TFN05t01">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antihypertensive drugs used before hospital admission, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Methyldopa alone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (39.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (30.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.6<a class="elsevierStyleCrossRef" href="#TFN05t01">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Methyldopa and pindolol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (8.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (8.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0<a class="elsevierStyleCrossRef" href="#TFN05t01">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Methyldopa and amlodipine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (4.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0<a class="elsevierStyleCrossRef" href="#TFN05t01">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Methyldopa, pindolol, and amlodipine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (4.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (8.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0<a class="elsevierStyleCrossRef" href="#TFN05t01">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pindolol alone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (8.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (17.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.381<a class="elsevierStyleCrossRef" href="#TFN05t01">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (35.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (35.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0<a class="elsevierStyleCrossRef" href="#TFN05t01">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes mellitus, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (21.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (39.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.2<a class="elsevierStyleCrossRef" href="#TFN05t01">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anesthesia and surgical time (min), median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120 (110-135) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120 (120-140) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.563<a class="elsevierStyleCrossRef" href="#TFN03t01">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blood pressure immediately before spinal anesthesia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Systolic pressure (mmHg), mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">170±20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">161±17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.148<a class="elsevierStyleCrossRef" href="#TFN02t01">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diastolic pressure (mmHg), mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">105±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100±11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.228<a class="elsevierStyleCrossRef" href="#TFN02t01">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "TFN02t01" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="cenpara10">t-Student test;</p>" ] 1 => array:3 [ "identificador" => "TFN03t01" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="cenpara20">Mann-Whitney test;</p>" ] 2 => array:3 [ "identificador" => "TFN04t01" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="cenpara30">Fisher's exact test;</p>" ] 3 => array:3 [ "identificador" => "TFN05t01" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="cenpara40">chi-square test.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Demographic and clinical characteristics of patients at baseline.</p>" ] ] 2 => array:7 [ "identificador" => "tbl2" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="TFN01t02" class="elsevierStyleSimplePara elsevierViewall">IQR: interquartile range; SD: Standard deviation;</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Restrictive Fluid(n=23) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Liberal Fluid(n=23) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"><span class="elsevierStyleItalic">p</span>-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">During surgery</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intraoperative fluid administration (ml), mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">272±26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1533±34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#TFN02t02">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intraoperative urine output (ml/h), median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 (37-110) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">116 (69-191) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.032 <a class="elsevierStyleCrossRef" href="#TFN03t02">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">During the first 8 postoperative hours</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cumulative fluid administration (ml), median±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">772±26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2033±35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#TFN02t02">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "TFN02t02" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="cenpara50">t-Student test</p>" ] 1 => array:3 [ "identificador" => "TFN03t02" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="cenpara60">Mann-Whitney test.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Intraoperative and postoperative fluid balance.</p>" ] ] 3 => array:7 [ "identificador" => "tbl3" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="TFN01t03" class="elsevierStyleSimplePara elsevierViewall">IQR: interquartile range; SD: Standard deviation; NGAL: neutrophil gelatinase-associated lipocalin; GFR: glomerular filtration rate; MDRD: Modification of Diet in Renal Disease.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Time point \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Restrictive Fluid(n=23) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Liberal Fluid(n=23) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"><span class="elsevierStyleItalic">p</span>-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Primary outcome</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AKIN stage≥1, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (43.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (43.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0<a class="elsevierStyleCrossRef" href="#TFN02t03">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AKIN graduation, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (26.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (30.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (17.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (8.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.540<a class="elsevierStyleCrossRef" href="#TFN03t03">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (4.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Creatinine (mg/dl), median (IQR)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preoperative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.73 (0.55-0.83) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.69 (0.55-0.83) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.879<a class="elsevierStyleCrossRef" href="#TFN04t03">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative day 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.93 (0.76-1.25) <a class="elsevierStyleCrossRef" href="#TFN07t03">†</a><a class="elsevierStyleCrossRef" href="#TFN05t03">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.99 (0.80-1.22) <a class="elsevierStyleCrossRef" href="#TFN07t03">†</a><a class="elsevierStyleCrossRef" href="#TFN05t03">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.704<a class="elsevierStyleCrossRef" href="#TFN06t03">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative day 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.84 (0.69-1.08) <a class="elsevierStyleCrossRef" href="#TFN07t03">†</a><a class="elsevierStyleCrossRef" href="#TFN08t03">‡</a><a class="elsevierStyleCrossRef" href="#TFN05t03">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.96 (0.80-1.09) <a class="elsevierStyleCrossRef" href="#TFN07t03">†</a><a class="elsevierStyleCrossRef" href="#TFN05t03">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.316<span class="elsevierStyleSup">c</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Secondary outcomes</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cystatin C (mg/L), mean±SD</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preoperative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.99±0.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.73±0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.627<a class="elsevierStyleCrossRef" href="#TFN06t03">e</a></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative day 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.03±0.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.93±0.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative day 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.72±0.43<a class="elsevierStyleCrossRef" href="#TFN08t03">‡</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.64±0.5<a class="elsevierStyleCrossRef" href="#TFN08t03">‡</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NGAL (mg/L), median (IQR)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preoperative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 (0.13-0.22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.16 (0.10-0.20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.448<a class="elsevierStyleCrossRef" href="#TFN04t03">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative day 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.21 (0.16-0.29) <a class="elsevierStyleCrossRef" href="#TFN07t03">†</a><a class="elsevierStyleCrossRef" href="#TFN05t03">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.18 (0.13-0.26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.255<a class="elsevierStyleCrossRef" href="#TFN04t03">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative day 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 (0.11-0.22)<a class="elsevierStyleCrossRef" href="#TFN08t03">‡</a><a class="elsevierStyleCrossRef" href="#TFN05t03">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 (0.10-0.24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.945<a class="elsevierStyleCrossRef" href="#TFN04t03">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GFR (ml/min/1.73 m<span class="elsevierStyleSup">2</span>), mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preoperative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">109.56±51.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">102.43±27.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MDRD<a class="elsevierStyleCrossRef" href="#TFN09t03">*</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative day 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.72±25.68<a class="elsevierStyleCrossRef" href="#TFN07t03">†</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.62±22.74<a class="elsevierStyleCrossRef" href="#TFN07t03">†</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.800<a class="elsevierStyleCrossRef" href="#TFN06t03">e</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative day 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78.56±23.34<a class="elsevierStyleCrossRef" href="#TFN07t03">†</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.24±26.67<a class="elsevierStyleCrossRef" href="#TFN07t03">†</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Serum creatinine/cystatin C<a class="elsevierStyleCrossRef" href="#TFN10t03">#</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preoperative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.87±18.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.73±22.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative day 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.67±23.06<a class="elsevierStyleCrossRef" href="#TFN07t03">†</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.27±17.06<a class="elsevierStyleCrossRef" href="#TFN07t03">†</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.150<a class="elsevierStyleCrossRef" href="#TFN06t03">e</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative day 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.53±20.13<a class="elsevierStyleCrossRef" href="#TFN08t03">‡</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.67±21.95<a class="elsevierStyleCrossRef" href="#TFN08t03">‡</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Proteinuria (g/L), median (IQR)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preoperative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.63 (0.80-9.60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.46 (0.32-1.71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.062<a class="elsevierStyleCrossRef" href="#TFN04t03">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative day 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.40 (0.28-0.58) <a class="elsevierStyleCrossRef" href="#TFN07t03">†</a><a class="elsevierStyleCrossRef" href="#TFN05t03">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 (0.10-0.88) <a class="elsevierStyleCrossRef" href="#TFN07t03">†</a><a class="elsevierStyleCrossRef" href="#TFN05t03">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.208<a class="elsevierStyleCrossRef" href="#TFN04t03">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative day 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.45 (0.10-2.23) <a class="elsevierStyleCrossRef" href="#TFN07t03">†</a><a class="elsevierStyleCrossRef" href="#TFN05t03">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.20 (0.10-0.48) <a class="elsevierStyleCrossRef" href="#TFN07t03">†</a><a class="elsevierStyleCrossRef" href="#TFN05t03">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.257<a class="elsevierStyleCrossRef" href="#TFN04t03">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Platelet count (cells × 10<span class="elsevierStyleSup">3</span>/mm<span class="elsevierStyleSup">3</span>), mean±SD</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preoperative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">207.94±71.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">194.40±77.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative day 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">201.11±61.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">183.25±83.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.390<a class="elsevierStyleCrossRef" href="#TFN06t03">e</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative day 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">221.82±62.92<a class="elsevierStyleCrossRef" href="#TFN08t03">‡</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">192.85±80.69<a class="elsevierStyleCrossRef" href="#TFN08t03">‡</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:9 [ 0 => array:3 [ "identificador" => "TFN02t03" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="cenpara70">chi-squared;</p>" ] 1 => array:3 [ "identificador" => "TFN03t03" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="cenpara80">Mann-Whitney test;</p>" ] 2 => array:3 [ "identificador" => "TFN04t03" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="cenpara90">Kruskal-Wallis;</p>" ] 3 => array:3 [ "identificador" => "TFN05t03" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="cenpara100">Friedman test;</p>" ] 4 => array:3 [ "identificador" => "TFN06t03" "etiqueta" => "e" "nota" => "<p class="elsevierStyleNotepara" id="cenpara110">repeated-measures analysis of variance;</p>" ] 5 => array:3 [ "identificador" => "TFN07t03" "etiqueta" => "†" "nota" => "<p class="elsevierStyleNotepara" id="cenpara120"><span class="elsevierStyleItalic">p</span><0.05 versus preoperative;</p>" ] 6 => array:3 [ "identificador" => "TFN08t03" "etiqueta" => "‡" "nota" => "<p class="elsevierStyleNotepara" id="cenpara130"><span class="elsevierStyleItalic">P</span><0.05 versus postoperative day 1.</p>" ] 7 => array:3 [ "identificador" => "TFN09t03" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="cenpara140">Calculated as 175 × creatinine<span class="elsevierStyleSup">−1.154</span> × age<span class="elsevierStyleSup">−0.203</span> × 0.742 × 1.21 (if black).</p>" ] 8 => array:3 [ "identificador" => "TFN10t03" "etiqueta" => "#" "nota" => "<p class="elsevierStyleNotepara" id="cenpara150">Calculated on the basis of serum creatinine (Scr, in mg/dl) and serum cystatin C (Scys, in mg/L), as follows:</p> <p class="elsevierStyleNotepara" id="cenpara160">If Scr≤0.7 and Scys ≤ 0.8—130 × (Scr/0.7)<span class="elsevierStyleSup">−0.248</span> × (Scys/0.8)<span class="elsevierStyleSup">−0.375</span> × 0.995<span class="elsevierStyleSup">Age</span> [× 1.08 if black].</p> <p class="elsevierStyleNotepara" id="cenpara170">If Scr≤0.7 and Scys > 0.8—130 × (Scr/0.7)<span class="elsevierStyleSup">−0.248</span> × (Scys/0.8)<span class="elsevierStyleSup">−0.711</span> × 0.995<span class="elsevierStyleSup">Age</span> [× 1.08 if black].</p> <p class="elsevierStyleNotepara" id="cenpara180">If Scr > 0.7 and Scys ≤ 0.8—130 × (Scr/0.7)<span class="elsevierStyleSup">−0.601</span> × (Scys/0.8)<span class="elsevierStyleSup">−0.375</span> × 0.995<span class="elsevierStyleSup">Age</span> [× 1.08 if black].</p> <p class="elsevierStyleNotepara" id="cenpara190">If Scr > 0.7 and Scys > 0.8—130 × (Scr/0.7)<span class="elsevierStyleSup">−0.601</span> × (Scys/0.8)<span class="elsevierStyleSup">−0.711</span> × 0.995<span class="elsevierStyleSup">Age</span> [× 1.08 if black].</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara40" class="elsevierStyleSimplePara elsevierViewall">Primary and secondary outcomes.</p>" ] ] 4 => array:6 [ "identificador" => "tbl4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => false "mostrarDisplay" => true "tabla" => array:3 [ "leyenda" => "<p id="TFN06t04" class="elsevierStyleSimplePara elsevierViewall">IQR: interquartile range; AKIN: Acute Kidney Injury Network; ICU: intensive care unit.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Restrictive Fluid(n=23) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Liberal Fluid(n=23) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"><span class="elsevierStyleItalic">p</span>-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intraoperative medication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vasodilator, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (4.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (8.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0<a class="elsevierStyleCrossRef" href="#TFN01t04">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vasopressor, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (78.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (65.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.326<a class="elsevierStyleCrossRef" href="#TFN02t04">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Metaraminol (mg), median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.2 (0.9–2.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.8 (0.6–1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.039<a class="elsevierStyleCrossRef" href="#TFN03t04">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemodialysis, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (4.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0<a class="elsevierStyleCrossRef" href="#TFN01t04">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Supplemental oxygen use, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (30.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.843<a class="elsevierStyleCrossRef" href="#TFN02t04">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ICU admission, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2<a class="elsevierStyleCrossRef" href="#TFN05t04">*</a> (8.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.489<a class="elsevierStyleCrossRef" href="#TFN01t04">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time to discharge after surgery (days), median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (3–5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (3–3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.196<a class="elsevierStyleCrossRef" href="#TFN03t04">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Apgar score, median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>At 1 minute \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (7–9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (7–8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.663<a class="elsevierStyleCrossRef" href="#TFN03t04">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>At 5 minutes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (8–10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (9–9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.621<a class="elsevierStyleCrossRef" href="#TFN03t04">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Umbilical cord blood gases, mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.23±0.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.22±0.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.647<a class="elsevierStyleCrossRef" href="#TFN04t04">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bicarbonate (mEq/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.71±4.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.13±2.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.190<a class="elsevierStyleCrossRef" href="#TFN04t04">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Base excess \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−5.71±2.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−6.52±3.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.414<a class="elsevierStyleCrossRef" href="#TFN04t04">d</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:5 [ 0 => array:3 [ "identificador" => "TFN01t04" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="cenpara200">Fisher's exact test;</p>" ] 1 => array:3 [ "identificador" => "TFN02t04" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="cenpara210">chi-square test;</p>" ] 2 => array:3 [ "identificador" => "TFN03t04" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="cenpara220">Mann–Whitney test;</p>" ] 3 => array:3 [ "identificador" => "TFN04t04" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="cenpara230">t-Student test.</p>" ] 4 => array:3 [ "identificador" => "TFN05t04" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="cenpara240">one case of uterine atony and one case of persistent oliguria and neurological symptoms.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara50" class="elsevierStyleSimplePara elsevierViewall">Intraoperative and postoperative variables in patients with preeclampsia, by the type of fluid therapy applied during cesarean section: post-hoc analyses.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec10" "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ JA Hutcheon \n \t\t\t\t\t\t\t\t """ 1 => """ S Lisonkova \n \t\t\t\t\t\t\t\t """ 2 => """ KS Joseph \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Best Pract Res Clin Obstet Gynaecol" "fecha" => "2011" "volumen" => "25" "numero" => "4" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://doi.org/10.1016/j.bpobgyn.2011.01.006" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy" "etal" => false ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1097/01.AOG.0000437382.03963.88" "Revista" => array:7 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "2013" "volumen" => "122" "numero" => "5" "paginaInicial" => "1122" "paginaFinal" => "1131" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24150027" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1097/01.AOG.0000437382.03963.88" "WWW" => array:1 [ "link" => "https://doi.org/10.1097/01.AOG.0000437382.03963.88" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypertensive disorders of pregnancy and the recent increase in obstetric acute renal failure in Canada: population based retrospective cohort study. 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Year/Month | Html | Total | |
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2024 November | 5 | 5 | 10 |
2024 October | 27 | 33 | 60 |
2024 September | 29 | 27 | 56 |
2024 August | 32 | 32 | 64 |
2024 July | 24 | 28 | 52 |
2024 June | 28 | 26 | 54 |
2024 May | 28 | 11 | 39 |
2024 April | 29 | 27 | 56 |
2024 March | 20 | 23 | 43 |
2024 February | 27 | 18 | 45 |
2024 January | 17 | 23 | 40 |
2023 December | 13 | 24 | 37 |
2023 November | 25 | 21 | 46 |
2023 October | 20 | 32 | 52 |
2023 September | 18 | 24 | 42 |
2023 August | 27 | 6 | 33 |
2023 July | 15 | 18 | 33 |
2023 June | 24 | 21 | 45 |
2023 May | 35 | 2 | 37 |
2023 April | 34 | 0 | 34 |
2023 March | 26 | 3 | 29 |
2023 February | 9 | 2 | 11 |
2023 January | 5 | 2 | 7 |
2022 December | 34 | 3 | 37 |
2022 November | 3 | 0 | 3 |