High-density Lipoprotein Cholesterol Concentration and acute kidney injury after noncardiac surgery

Background: Abnormal High-density Lipoprotein Cholesterol Concentration is closely related to postoperative acute kidney injury (AKI) after cardiac surgeries. The purpose of this study was to analyze the relationship between High-density Lipoprotein Cholesterol Concentration and acute kidney injury after non-cardiac surgeries. Method: This was a single-center cohort study for elective non-cardiac non-kidney surgery from January 1, 2012, to December 31, 2017. The endpoint was the occurrence of acute kidney injury (AKI) 7 days postoperatively in the hospital. Preoperative serum High-density Lipoprotein Cholesterol Concentration was examined by multivariate logistic regression models before and after propensity score weighting analysis. Results: Of the 74284 surgeries, 4.4% (3159 cases) suffered acute kidney injury. The odds ratio for HDL (0.96-1.14 as reference, < 0.96, 1.14 -1.35, > 1.35) was 1.28 (1.14 - 1.41), P < 0.001; 0.91 (0.80 - 1.03), P = 0.150; 0.75 (0.64 - 0.85), P < 0.001, respectively. Using a dichotomized cutoff point for propensity analysis, Preoperative serum HDL < 1.03 mmol/L (> 1.03 as reference) was associated with increased risk of postoperative AKI, with odds ratio 1.32 (1.21 - 1.46), P < 0.001 before propensity score weighting, and 1.32 (1.18 - 1.48), P < 0.001 after propensity score weighting. Sensitivity analysis with other cut values of HDL showed similar results. Conclusions: Using multivariate regression analyses before and after propensity score weighting, in addition to multiple sensitivity analysis methods, this study found that following non-cardiac surgery, low HDL cholesterol levels were independent risk factors for AKI.