Key result
Persistent postoperative creatinine rise is linked to higher 1-year mortality after cardiac surgery in elderly patients.
Why the study?
Conventional monitoring of serum creatinine at isolated time points is suboptimal for reflecting disease progression.
Do distinct postoperative serum creatinine trajectories predict all-cause mortality in elderly patients after cardiac surgery?
Cohort (n=5,145)
No
Do distinct postoperative serum creatinine trajectories predict all-cause mortality in elderly patients after cardiac surgery?
Distinct postoperative serum creatinine trajectories, particularly a persistent increase, independently predict higher 1-year all-cause mortality in elderly patients following cardiac surgery.
May support trajectory-based risk stratification post-cardiac surgery in elderly patients; hypothesis-generating and requires prospective validation.
PURPOSE: Conventional monitoring of serum creatinine at isolated time points is suboptimal for reflecting disease progression. We therefore evaluated the prognostic value of distinct serum creatinine trajectories for predicting all-cause mortality in this patient population. METHODS: We conducted a retrospective cohort study of elderly patients undergoing cardiac surgery, using data from the Medical Information Mart for Intensive Care database (MIMIC-IV). Kaplan-Meier analysis compared survival outcomes among the identified classes. Multivariable logistic and Cox proportional hazards models determined the independent associations of these trajectories with in-hospital and 1-year all-cause mortality. RESULTS: A total of 5145 patients undergoing cardiac surgery were included in the analysis. Three distinct creatinine trajectories were identified: low-stable (Class 1), persistent-increase (Class 2), and transient-increase (Class 3). Class 1 had the lowest in-hospital and 1-year mortality rates. Using Class 1 as the reference, Class 2 demonstrated the highest mortality risk, followed by Class 3. CONCLUSION: Distinct creatinine trajectory patterns conferred independent prognostic value for postoperative outcomes in elderly patients after cardiac surgery. A persistently high trajectory was independently associated with significantly increased mortality compared to the low-stable trajectory class.
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Fan et al. (2026) conducted a cohort in Elderly patients after cardiac surgery (n=5,145). Persistent-increase creatinine trajectory vs. Low-stable creatinine trajectory was evaluated on 1-year all-cause mortality. A persistently increasing postoperative serum creatinine trajectory was independently associated with significantly higher 1-year all-cause mortality compared to a low-stable trajectory in elderly patients following cardiac surgery.
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