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Determinants of postoperative acute kidney injury.
Crit Care. 2009; 13(3):R79.CC

Abstract

INTRODUCTION

Development of acute kidney injury (AKI) during the perioperative period is associated with increases in morbidity and mortality. Our aim was to evaluate the incidence and determinants of postoperative AKI after major noncardiac surgery in patients with previously normal renal function.

METHODS

This retrospective cohort study was carried out in the multidisciplinary Post-Anaesthesia Care Unit (PACU) with five intensive care beds. The study population consisted of 1166 patients with no previous renal insufficiency who were admitted to these intensive care unit (ICU) beds over 2 years. After admission patients were followed for the development of AKI, defined as proposed by The Acute Kidney Injury Network (increment of serum creatinine [greater than or equal to] 0.3 mg/dL or 50% from baseline within 48 hours or urine output < 0.5 mL/kg/hr for > 6 hours despite fluid resuscitation when applicable). Patient preoperative characteristics, intraoperative management and outcome were evaluated for associations with acute kidney injury using an univariate and multiple logistic regression model.

RESULTS

A total of 1597 patients were admitted to the PACU and of these, 1166 met the inclusion criteria. Eighty-seven patients (7.5%) met AKI criteria. Univariate analysis identified age, American Society of Anesthesiologists (ASA) physical status, emergency surgery, high risk surgery, ischemic heart disease, congestive heart disease and Revised Cardiac Risk Index (RCRI) score as independent preoperative determinants for AKI in the postoperative period. Multivariate analysis identified ASA physical status, RCRI score, high risk surgery and congestive heart disease as preoperative determinants for AKI in the postoperative period. Patients that developed AKI had higher Simplified Acute Physiology Score (SAPS) II and Acute Physiology and Chronic Health Evaluation (APACHE) II, higher PACU length of stay (LOS), higher PACU mortality, higher hospital mortality and higher mortality at 6 months follow-up. AKI was an independent risk factor for hospital mortality (OR 3.12, 95% CI 1.41 to 6.93, P = 0.005).

CONCLUSIONS

This study shows that age, emergency and high risk surgery, ischemic heart disease, congestive heart disease, ASA physical status and RCRI score were considered risk factors for the development of AKI, in patients needing intensive care after surgery. AKI has serious impact on PACU length of stay and mortality. AKI was an independent risk factor for hospital mortality.

Authors+Show Affiliations

Department of Anesthesiology, Hospital de São João, Alameda Professor Hernani Monteiro, Porto 4202-451, Portugal. abelha@mail.telepac.ptNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19463152

Citation

Abelha, Fernando José, et al. "Determinants of Postoperative Acute Kidney Injury." Critical Care (London, England), vol. 13, no. 3, 2009, pp. R79.
Abelha FJ, Botelho M, Fernandes V, et al. Determinants of postoperative acute kidney injury. Crit Care. 2009;13(3):R79.
Abelha, F. J., Botelho, M., Fernandes, V., & Barros, H. (2009). Determinants of postoperative acute kidney injury. Critical Care (London, England), 13(3), R79. https://doi.org/10.1186/cc7894
Abelha FJ, et al. Determinants of Postoperative Acute Kidney Injury. Crit Care. 2009;13(3):R79. PubMed PMID: 19463152.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Determinants of postoperative acute kidney injury. AU - Abelha,Fernando José, AU - Botelho,Miguela, AU - Fernandes,Vera, AU - Barros,Henrique, Y1 - 2009/05/22/ PY - 2009/02/23/received PY - 2009/04/21/revised PY - 2009/05/22/accepted PY - 2009/5/26/entrez PY - 2009/5/26/pubmed PY - 2009/10/29/medline SP - R79 EP - R79 JF - Critical care (London, England) JO - Crit Care VL - 13 IS - 3 N2 - INTRODUCTION: Development of acute kidney injury (AKI) during the perioperative period is associated with increases in morbidity and mortality. Our aim was to evaluate the incidence and determinants of postoperative AKI after major noncardiac surgery in patients with previously normal renal function. METHODS: This retrospective cohort study was carried out in the multidisciplinary Post-Anaesthesia Care Unit (PACU) with five intensive care beds. The study population consisted of 1166 patients with no previous renal insufficiency who were admitted to these intensive care unit (ICU) beds over 2 years. After admission patients were followed for the development of AKI, defined as proposed by The Acute Kidney Injury Network (increment of serum creatinine [greater than or equal to] 0.3 mg/dL or 50% from baseline within 48 hours or urine output < 0.5 mL/kg/hr for > 6 hours despite fluid resuscitation when applicable). Patient preoperative characteristics, intraoperative management and outcome were evaluated for associations with acute kidney injury using an univariate and multiple logistic regression model. RESULTS: A total of 1597 patients were admitted to the PACU and of these, 1166 met the inclusion criteria. Eighty-seven patients (7.5%) met AKI criteria. Univariate analysis identified age, American Society of Anesthesiologists (ASA) physical status, emergency surgery, high risk surgery, ischemic heart disease, congestive heart disease and Revised Cardiac Risk Index (RCRI) score as independent preoperative determinants for AKI in the postoperative period. Multivariate analysis identified ASA physical status, RCRI score, high risk surgery and congestive heart disease as preoperative determinants for AKI in the postoperative period. Patients that developed AKI had higher Simplified Acute Physiology Score (SAPS) II and Acute Physiology and Chronic Health Evaluation (APACHE) II, higher PACU length of stay (LOS), higher PACU mortality, higher hospital mortality and higher mortality at 6 months follow-up. AKI was an independent risk factor for hospital mortality (OR 3.12, 95% CI 1.41 to 6.93, P = 0.005). CONCLUSIONS: This study shows that age, emergency and high risk surgery, ischemic heart disease, congestive heart disease, ASA physical status and RCRI score were considered risk factors for the development of AKI, in patients needing intensive care after surgery. AKI has serious impact on PACU length of stay and mortality. AKI was an independent risk factor for hospital mortality. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/19463152/Determinants_of_postoperative_acute_kidney_injury_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/cc7894 DB - PRIME DP - Unbound Medicine ER -