Key result
Each 0.1 mg/dl preoperative creatinine rise is linked to ~51% higher postoperative AKI risk.
Why the study?
Preoperative serum creatinine fluctuations are common in open-heart surgery, but their association with postoperative AKI and combined impact on outcomes required further investigation.
Does preoperative serum creatinine change predict postoperative acute kidney injury and mortality in patients undergoing open-heart surgery?
Cohort (n=560)
No
Does preoperative serum creatinine change predict postoperative acute kidney injury and mortality in patients undergoing open-heart surgery?
Odds Ratio: 1.51 (95% CI 1.32–1.72)
Negative changes in preoperative serum creatinine are associated with a lower risk of postoperative AKI but predict higher in-hospital mortality and prolonged ICU stay in patients who do develop AKI after cardiac surgery.
May inform preoperative risk stratification for AKI and mortality after cardiac surgery; hypothesis-generating pending prospective validation.
Introduction: Preoperative serum creatinine fluctuations are common in open-heart surgery, and their association with postoperative acute kidney injury (AKI) and the combined impact on patient outcomes warrant further investigation. Methods: This retrospective cohort study assessed patients undergoing open-heart surgery. Preoperative serum creatinine changes (ΔScr) were calculated as the difference between the serum creatinine value within 48 h before surgery and baseline. Patients were categorized into three groups based on ΔScr: negative (< 0 mg/dl), normal (0-0.3 mg/dl), and elevated (≥0.3 mg/dl). Multivariable logistic regression and restricted cubic spline models were used to analyze the clinical outcomes. Results: Of the 560 patients included, 40.2% developed AKI. There were significant increases in the odds of AKI [adjusted odds ratio (AOR), 1.51; 95% CI, 1.32-1.72, per 0.1 mg/dl increase], severe AKI (AOR, 1.45; 95% CI, 1.24-1.70), and AKI non-recovery (AOR, 1.37; 95% CI, 1.19-1.59). In AKI patients, negative ΔScr was associated with a higher rate of in-hospital mortality and ICU LOS >72 h compared to without AKI, while elevated ΔScr showed no significant differences. In addition, negative ΔScr was associated with a higher risk of in-hospital mortality (AOR, 4.50; 95% CI, 1.00-20.15) and ICU LOS >72 hours (AOR, 2.81; 95% CI, 1.13-6.96) compared with normal ΔScr. No significant associations were observed with elevated ΔScr. In contrast, among patients without AKI, neither negative nor elevated ΔScr were associated with in-hospital mortality or prolonged ICU LOS. Conclusions: In this retrospective study of elective cardiac surgery, negative changes in preoperative serum creatinine were less likely to development of AKI. However, patients with negative changes who developed postoperative AKI had a higher risk of in-hospital mortality and prolonged ICU stays. No significant associations with these outcomes were observed with elevated changes.
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Jiang et al. (2026) conducted a cohort in Patients undergoing open-heart surgery (n=560). Preoperative serum creatinine changes vs. Normal preoperative serum creatinine changes (0-0.3 mg/dl) was evaluated on Acute kidney injury (per 0.1 mg/dl increase in preoperative serum creatinine) (AOR 1.51, 95% CI 1.32-1.72). Each 0.1 mg/dl increase in preoperative serum creatinine was associated with a significantly higher risk of developing acute kidney injury after open-heart surgery (AOR 1.51).
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