Perioperative body weight change is associated with in-hospital mortality in cardiac surgical patients with postoperative acute kidney injury

PLoS One. 2017 Nov 17;12(11):e0187280. doi: 10.1371/journal.pone.0187280. eCollection 2017.

Abstract

Background: Postoperative acute kidney injury (AKI) is common following cardiac surgery (CS). Body weight (BW) may be an amenable variable by representing the summation of the nutritional and the fluid status. However, the predictive role of perioperative BW changes in CS patients with severe postoperative AKI is never explored. This study aimed to evaluate this association.

Methods: This study was conducted using a prospectively collected multicenter cohort, NSARF (National Taiwan University Hospital Study Group on Acute Renal Failure) database. The adult CS patients with postoperative AKI requiring renal replacement therapy (RRT), who had clear initial consciousness, received CS within 14 days of hospitalization, and underwent RRT within seven days after CS in intensive care units from January 2001 to January 2014 were enrolled. With the endpoint of 30-day postoperative mortality, we evaluated the association between the clinical factors denoting fluid status and patients outcomes.

Results: A total of 188 patients (70 female, mean age 63.7 ± 15.2 years) were enrolled. Comparing with the survivors (n = 124), the non-survivors (n = 64) had a significantly higher perioperative BW change [3.6 ± 6.1% versus 0.1 ± 8.3%, p = 0.003] but not the postoperative and pre-RRT BW changes. By using multivariate Cox proportional hazards model, the independent indicators of 30-day postoperative mortality included perioperative BW change (p = 0.026) and packed red blood cells transfusion (p = 0.007), postoperative intra-aortic balloon pump (p = 0.001) and central venous pressure level (p = 0.005), as well as heart rate (p = 0.022), sequential organ failure assessment score (p < 0.001), logistic organ dysfunction score (p = 0.001), and blood total bilirubin level (p = 0.044) at RRT initiation. The generalized additive models further demonstrated, in a multivariate manner, that the mortality risk rose significantly during a perioperative BW change of 2% to 15%.

Conclusions: Perioperative BW change was independently associated with an increased risk for 30-day postoperative mortality in CS patients with RRT-requiring AKI.

MeSH terms

  • Acute Kidney Injury / complications*
  • Aged
  • Body Weight*
  • Cardiac Surgical Procedures*
  • Female
  • Hospital Mortality*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications*
  • Prospective Studies

Grants and funding

This study was financially supported by The Ta-Tung Kidney Foundation, Taiwan National Science Council (grant NSC 96-2314-B-002-164, NSC 96-2314-B-002-033-MY3, NSC 97-2314-B-002-155-MY2, NSC 98-2314-B-002-155-MY4), 101-2314-B-002-085-MY3, 102-2314-B-002-140-MY2, 104-2314-B-002-125-MY3), NTUH (106-FTN20, 106-P02, UN106-014, 106-S3582, 105-P05, VN105-04, 105-S3061, VN104-07, 104-S2718, and NTUH 098-001177, NTUH 100-001667. This study was also supported by the Ministry of Science and Technology (MOST) of the Re-public of China (Taiwan) (grant number, MOST 106-2321-B-182-002). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.