Key result
A greater than 15% increase in immediate post-operative serum creatinine was independently associated with a 7-fold increased odds of developing acute kidney injury.
Why the study?
Does immediate post-operative serum creatinine accurately predict the development of acute kidney injury in patients undergoing elective on-pump cardiac surgery?
Cohort (n=196)
No
Does immediate post-operative serum creatinine accurately predict the development of acute kidney injury in patients undergoing elective on-pump cardiac surgery?
Answers are grounded in this paper and cite their sources.
Immediate post-operative serum creatinine measured within 2 hours of cardiac surgery is an independent predictor of acute kidney injury and improves risk prediction models.
BACKGROUND: Acute Kidney Injury (AKI) is a well recognized complication of cardiac surgery. It is associated with significant morbidity and mortality. The aims of our study are twofold; 1. To define the incidence of AKI post cardiac surgery. 2. To identify pre-morbid and operative risk factors for developing AKI and to determine if immediate post operative serum creatinine (IPOsCr) accurately predicts the development of AKI. METHODS: We prospectively studied 196 consecutive patients undergoing elective (on-pump) cardiac surgery. Baseline patient characteristics, including medical co-morbidities, proteinuria, procedural data and kidney function (serum creatinine (sCr) were collected. Internationally standardised criteria for AKI were used (sCr >1.5 times baseline, elevation in sCr >26.4 μmmol/L (0.3 mg/dl). Measurements were collected pre-operatively, within 2 h of surgical completion (IPOsCr) and daily for two days. Logistic regression was used to assess predictive factors for AKI including IPOsCr. Model discrimination was assessed using ROC AUC curves. RESULTS: Forty (20.4%) patients developed AKI postoperatively. Hypertension (OR 2.64, p = 0.02), diabetes (OR 2.25, p = 0.04), proteinuria (OR 2.48, p = 0.02) and a lower baseline eGFR (OR 0.74, p = 0.002) were associated with AKI in univariate analysis. A multivariate logistic model with preoperative and surgical factors (age, gender, eGFR, proteinuria, hypertension, diabetes and type of cardiac surgery) demonstrated moderate discrimination for AKI (ROC AUC 0.76). The addition of IPOsCr improved model discrimination for AKI (AUC 0.82, p = 0.07 versus baseline AUC) and was independently associated with AKI (OR 7.17; 95% CI 1.27-40.32; p = 0.025). CONCLUSIONS: One in 5 patients developed AKI post cardiac surgery. These patients have significantly increased morbidity and mortality. IPOsCr is significantly associated with the development of AKI, providing a cheap readily available prognostic marker.
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Grynberg et al. (2017) conducted a cohort in Acute Kidney Injury (AKI) post cardiac surgery (n=196). Immediate post-operative serum creatinine (IPOsCr) >15% increase vs. IPOsCr change <15% or decrease was evaluated on Development of Acute Kidney Injury (AKI) postoperatively (OR 7.17, 95% CI 1.27-40.32, p=0.025). A greater than 15% increase in immediate post-operative serum creatinine was independently associated with a 7-fold increased odds of developing acute kidney injury.
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