TY - JOUR
T1 - Acute Kidney Injury and Risk of Death After Elective Surgery
T2 - Prospective Analysis of Data From an International Cohort Study
AU - International Surgical Outcomes Study (ISOS) group
AU - Chaudery, Hannan
AU - MacDonald, Neil
AU - Ahmad, Tahania
AU - Chandra, Susilo
AU - Tantri, Aida
AU - Sivasakthi, Velayuthapillai
AU - Mansor, Marzida
AU - Matos, Ricardo
AU - Pearse, Rupert M
AU - Prowle, John R
AU - Study group members AMC, null
AU - Hollmann, Markus
AU - Preckel, Benedikt
AU - Hulst, Abraham H.
PY - 2019/5
Y1 - 2019/5
N2 - BACKGROUND: Postoperative acute kidney injury (AKI) is associated with a high mortality rate. However, the relationship among AKI, its associations, and mortality is not well understood.METHODS: Planned analysis of data was collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. AKI was defined using Kidney Disease Improving Global Outcomes criteria. Patients missing preoperative creatinine data were excluded. We used multivariable logistic regression to examine the relationships among preoperative creatinine-based estimated glomerular filtration rate (eGFR), postoperative AKI, and hospital mortality, accounting for the effects of age, major comorbid diseases, and nature and severity of surgical intervention on outcomes. We similarly modeled preoperative associations of AKI. Data are presented as n (%) or odds ratios (ORs) with 95% confidence intervals.RESULTS: A total of 36,357 patients were included, 743 (2.0%) of whom developed AKI with 73 (9.8%) deaths in hospital. AKI affected 73 of 196 (37.2%) of all patients who died. Mortality was strongly associated with the severity of AKI (stage 1: OR, 2.57 [1.3-5.0]; stage 2: OR, 8.6 [5.0-15.1]; stage 3: OR, 30.1 [18.5-49.0]). Low preoperative eGFR was strongly associated with AKI. However, in our model, lower eGFR was not associated with increasing mortality in patients who did not develop AKI. Conversely, in older patients, high preoperative eGFR (>90 mL·minute·1.73 m) was associated with an increasing risk of death, potentially reflecting poor muscle mass.CONCLUSIONS: The occurrence and severity of AKI are strongly associated with risk of death after surgery. However, the relationship between preoperative renal function as assessed by serum creatinine-based eGFR and risk of death dependent on patient age and whether AKI develops postoperatively.
AB - BACKGROUND: Postoperative acute kidney injury (AKI) is associated with a high mortality rate. However, the relationship among AKI, its associations, and mortality is not well understood.METHODS: Planned analysis of data was collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. AKI was defined using Kidney Disease Improving Global Outcomes criteria. Patients missing preoperative creatinine data were excluded. We used multivariable logistic regression to examine the relationships among preoperative creatinine-based estimated glomerular filtration rate (eGFR), postoperative AKI, and hospital mortality, accounting for the effects of age, major comorbid diseases, and nature and severity of surgical intervention on outcomes. We similarly modeled preoperative associations of AKI. Data are presented as n (%) or odds ratios (ORs) with 95% confidence intervals.RESULTS: A total of 36,357 patients were included, 743 (2.0%) of whom developed AKI with 73 (9.8%) deaths in hospital. AKI affected 73 of 196 (37.2%) of all patients who died. Mortality was strongly associated with the severity of AKI (stage 1: OR, 2.57 [1.3-5.0]; stage 2: OR, 8.6 [5.0-15.1]; stage 3: OR, 30.1 [18.5-49.0]). Low preoperative eGFR was strongly associated with AKI. However, in our model, lower eGFR was not associated with increasing mortality in patients who did not develop AKI. Conversely, in older patients, high preoperative eGFR (>90 mL·minute·1.73 m) was associated with an increasing risk of death, potentially reflecting poor muscle mass.CONCLUSIONS: The occurrence and severity of AKI are strongly associated with risk of death after surgery. However, the relationship between preoperative renal function as assessed by serum creatinine-based eGFR and risk of death dependent on patient age and whether AKI develops postoperatively.
KW - Acute Kidney Injury/complications
KW - Aged
KW - Comorbidity
KW - Creatinine/blood
KW - Data Collection
KW - Elective Surgical Procedures/adverse effects
KW - Female
KW - Glomerular Filtration Rate
KW - Humans
KW - Internationality
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Odds Ratio
KW - Postoperative Complications/diagnosis
KW - Postoperative Period
KW - Prospective Studies
KW - Regression Analysis
KW - Risk
KW - Treatment Outcome
U2 - https://doi.org/10.1213/ANE.0000000000003923
DO - https://doi.org/10.1213/ANE.0000000000003923
M3 - Article
C2 - 30418232
SN - 0003-2999
VL - 128
SP - 1022
EP - 1029
JO - Anesthesia and analgesia
JF - Anesthesia and analgesia
IS - 5
ER -