Minor postoperative creatinine increases (25-49% above baseline but <0.3 mg/dl) were associated with increased in-hospital mortality (OR 1.7; 95% CI 1.3-2.4; P<0.001) and longer length of stay.
Observational (n=39,369)
No
Are minor postoperative increases in creatinine levels associated with higher mortality and longer hospital length of stay in surgical patients?
Even minor postoperative increases in creatinine levels not meeting AKI criteria are associated with significantly higher in-hospital mortality and longer hospital length of stay in surgical patients.
Effect estimate: OR 1.7 (95% CI 1.3 to 2.4)
p-value: p=< 0.001
BACKGROUND: Surgical patients frequently experience postoperative increases in creatinine levels. The authors hypothesized that even small increases in postoperative creatinine levels are associated with adverse outcomes. METHODS: The authors examined the association of postoperative changes from preoperative baseline creatinine with all-cause in-hospital mortality and hospital length of stay (HLOS) in a retrospective analysis of surgical patients at a single tertiary care center between January 2006 and June 2012. RESULTS: The data of 39,369 surgical patients (noncardiac surgery n = 37,345; cardiac surgery n = 2,024) were analyzed. Acute kidney injury (AKI)-by definition of the Kidney Disease: Improving Global Outcome group-was associated with a five-fold higher mortality (odds ratio OR, 4.8; 95% CI, 4.1 to 5.7; P < 0.001) and a longer HLOS of 5 days (P < 0.001) after adjusting for age, sex, comorbidities, congestive heart failure, preoperative hemoglobin, preoperative creatinine, exposure to radiocontrast agent, type of surgery, and surgical AKI risk factors. Importantly, even minor creatinine increases (Δcreatinine 25 to 49% above baseline but < 0.3 mg/dl) not meeting AKI criteria were associated with a two-fold increased risk of death (OR, 1.7; 95% CI, 1.3 to 2.4; P < 0.001) and 2 days longer HLOS (P < 0.001). This was more pronounced in noncardiac surgery patients. Patients with minor creatinine increases had a five-fold risk of death (OR, 5.4; 95% CI, 1.5 to 20.3; P < 0.05) and a 3-day longer HLOS (P < 0.01) when undergoing noncardiac surgery. CONCLUSIONS: Even minor postoperative increases in creatinine levels are associated with adverse outcomes. These results emphasize the importance to find effective therapeutic approaches to prevent or treat even mild forms of postoperative kidney dysfunction to improve surgical outcomes.
Kork et al. (Thu,) conducted a observational in Surgical patients (n=39,369). Minor postoperative increases in creatinine vs. Baseline creatinine/no increase was evaluated on All-cause in-hospital mortality (OR 1.7, 95% CI 1.3 to 2.4, p=< 0.001). Minor postoperative creatinine increases (25-49% above baseline but <0.3 mg/dl) were associated with increased in-hospital mortality (OR 1.7; 95% CI 1.3-2.4; P<0.001) and longer length of stay.