What is the clinical evidence from this study?

Study design: Cohort. Population: Elderly patients after cardiac surgery (n=5145). Intervention: Persistent-increase or transient-increase creatinine trajectories vs. Low-stable creatinine trajectory. Primary outcome: 1-year all-cause mortality.

What question did this study set out to answer?

The aim is to assess how changes in serum creatinine levels can predict mortality in elderly patients post-cardiac surgery.

April 4, 2026Annals of Thoracic and Cardiovascular Surgery0 citationsOpen Access

Association between Creatinine Trajectories and All-Cause Mortality in Elderly Patients after Cardiac Surgery: A Retrospective Cohort Study Based on MIMIC-IV

YFYujie FanShanxi Medical University ZYZefeng YangKunming University of Science and Technology JWJiayao WeiShanxi Medical University

Key Result

A persistently increasing postoperative creatinine trajectory was independently associated with significantly higher 1-year all-cause mortality compared to a low-stable trajectory in 5,145 elderly patients after cardiac surgery.

Key Points

The aim is to assess how changes in serum creatinine levels can predict mortality in elderly patients post-cardiac surgery.
Retrospective cohort design using MIMIC-IV database
Analysis of serum creatinine trajectories over time
Evaluation of all-cause mortality as the primary outcome
Distinct creatinine trajectories were associated with varying mortality rates
Patients with stable or decreasing creatinine levels showed lower mortality
Findings suggest that monitoring trends in creatinine improves prognostic accuracy

Study Design

Type

Cohort (n=5,145)

Multicenter

Structured PICO

Do distinct postoperative serum creatinine trajectories predict all-cause mortality in elderly patients after cardiac surgery?

Population

5,145 elderly patients (>65 years) who underwent cardiac surgery, median age 75.82, 65.6% female (per Table 2), 76.7% White, from the single-center MIMIC-IV database (US). Key comorbidities: 35.6% congestive heart failure, 30.0% prior myocardial infarction, 36.8% diabetes.

Intervention

Classification into distinct serum creatinine trajectories (Class 1: low-stable, Class 2: persistent-increase, Class 3: transient-increase) based on serial measurements over the first 4 postoperative days.

Comparator

Comparison among the three trajectory classes, with the 'low-stable' class (Class 1) serving as the reference.

Outcome

All-cause mortality (in-hospital, 30-day, 180-day, and 1-year after admission).hard clinical

Distinct postoperative serum creatinine trajectories, particularly a persistent increase, provide independent prognostic value for 1-year mortality in elderly patients following cardiac surgery.

Limitations

Data derived from a single US medical center, limiting generalizability
Exact calendar years could not be extracted due to random temporal shifts
Retrospective design cannot fully exclude confounding bias and unmeasured factors
Lack of daily fluid balance, urine output, and dynamic Sequential Organ Failure Assessment scores to comprehensively assess true renal function changes

Abstract

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.

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