Early postoperative change in serum creatinine predicts acute kidney injury after cardiothoracic surgery: a retrospective cohort study.
Acute kidney injury
Cardiothoracic surgery
Serum creatinine
Journal
Clinical and experimental nephrology
ISSN: 1437-7799
Titre abrégé: Clin Exp Nephrol
Pays: Japan
ID NLM: 9709923
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
received:
23
05
2018
accepted:
19
08
2018
pubmed:
31
8
2018
medline:
14
6
2019
entrez:
31
8
2018
Statut:
ppublish
Résumé
Acute kidney injury (AKI) is one of the most severe complications after cardiothoracic surgery (CTS). However, diagnosis of AKI by elevation of serum creatinine (SCr) misses a critical time period for prevention and treatment of AKI. We have observed that patients who develop AKI show a smaller SCr decrease after CTS than those without AKI. Hence, we hypothesized that the magnitude of the SCr change (ΔSCr) measured early after CTS can predict subsequent AKI. We conducted a retrospective analysis from January 2014 to December 2016 to examine the association of ΔSCr with AKI. ΔSCr was calculated as follows: (early postoperative SCr on intensive care unit [ICU] admission) - (preoperative SCr). Established risk factors and demographics were included in the multivariate-adjusted logistic regression model. AKI was defined by SCr criteria of the Kidney Disease: Improving Global Outcomes group. Among 252 patients who underwent CTS, 69 developed AKI. The median ΔSCr was - 0.14 mg/dL (range - 0.96-0.45). Patients were divided into three groups based on ΔSCr: Group 1, ≤ - 0.2 mg/dL (n = 84); Group 2, > - 0.2 to < - 0.1 mg/dL (n = 76); and Group 3, ≥ - 0.1 mg/dL (n = 92). In the multivariate analysis, Group 3 had a significantly higher incidence of AKI than Group 1 (odds ratio, 7.34; 95% confidence interval 2.55-23.3). ΔSCr was an independent risk factor for AKI (odds ratio for every 0.1-mg/dL increase in ΔSCr, 1.55; 95% confidence interval 1.23-1.97). A minor change in the SCr level early after CTS can predict subsequent AKI just after ICU admission.
Sections du résumé
BACKGROUND
BACKGROUND
Acute kidney injury (AKI) is one of the most severe complications after cardiothoracic surgery (CTS). However, diagnosis of AKI by elevation of serum creatinine (SCr) misses a critical time period for prevention and treatment of AKI. We have observed that patients who develop AKI show a smaller SCr decrease after CTS than those without AKI. Hence, we hypothesized that the magnitude of the SCr change (ΔSCr) measured early after CTS can predict subsequent AKI.
METHODS
METHODS
We conducted a retrospective analysis from January 2014 to December 2016 to examine the association of ΔSCr with AKI. ΔSCr was calculated as follows: (early postoperative SCr on intensive care unit [ICU] admission) - (preoperative SCr). Established risk factors and demographics were included in the multivariate-adjusted logistic regression model. AKI was defined by SCr criteria of the Kidney Disease: Improving Global Outcomes group.
RESULTS
RESULTS
Among 252 patients who underwent CTS, 69 developed AKI. The median ΔSCr was - 0.14 mg/dL (range - 0.96-0.45). Patients were divided into three groups based on ΔSCr: Group 1, ≤ - 0.2 mg/dL (n = 84); Group 2, > - 0.2 to < - 0.1 mg/dL (n = 76); and Group 3, ≥ - 0.1 mg/dL (n = 92). In the multivariate analysis, Group 3 had a significantly higher incidence of AKI than Group 1 (odds ratio, 7.34; 95% confidence interval 2.55-23.3). ΔSCr was an independent risk factor for AKI (odds ratio for every 0.1-mg/dL increase in ΔSCr, 1.55; 95% confidence interval 1.23-1.97).
CONCLUSIONS
CONCLUSIONS
A minor change in the SCr level early after CTS can predict subsequent AKI just after ICU admission.
Identifiants
pubmed: 30159689
doi: 10.1007/s10157-018-1638-3
pii: 10.1007/s10157-018-1638-3
doi:
Substances chimiques
Creatinine
AYI8EX34EU
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
325-334Références
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