Incidence and peri-operative risk factors for development of acute kidney injury in patients after cardiac surgery: A prospective observational study

Stavros Dimopoulos; Georgios Zagkotsis; Charalambia Kinti; Niki Rouvali; Magda Georgopoulou; Mariantzela Mavraki; Androniki Tasouli; Efterpi Lyberopoulou; Antonios Roussakis; Ioannis Vasileiadis; Serafim Nanas; Andreas Karabinis

doi:10.12998/wjcc.v11.i16.3791

Incidence and peri-operative risk factors for development of acute kidney injury in patients after cardiac surgery: A prospective observational study

World J Clin Cases. 2023 Jun 6;11(16):3791-3801. doi: 10.12998/wjcc.v11.i16.3791.

Affiliations

¹ Department of Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece.
² Department of Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens 10676, Greece. stdimop@med.uoa.gr.
³ Department of Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens 10676, Greece.

Abstract

Background: Patients admitted to intensive care unit (ICU) after cardiac surgery develop acute kidney injury (AKI) immediately post-operation. We hypothesized that AKI occurs mainly due to perioperative risk factors and may affect outcome.

Aim: To assess peri-operative risk factors for AKI post cardiac surgery and its relationship with clinical outcome.

Methods: This was an observational single center, tertiary care setting study, which enrolled 206 consecutive patients, admitted to ICU after cardiac surgery. Patients were followed-up until ICU discharge or death, in order to determine the incidence of AKI, perioperative risk factors for AKI and its association with outcome. Univariate and multivariate logistic regression analysis was performed to assess predictor variables for AKI development.

Results: After ICU admission, 55 patients (26.7%) developed AKI within 48 h. From the logistic regression analysis performed, high EuroScore II (OR: 1.18; 95%CI: 1.06-1.31, P = 0.003), white blood cells (WBC) pre-operatively (OR: 1.0; 95%CI: 1.0-1.0, P = 0.002) and history of chronic kidney disease (OR: 2.82; 95%CI: 1.195-6.65, P = 0.018) emerged as independent predictors of AKI among univariate predictors. AKI that developed AKI had longer duration of mechanical ventilation [1113 (777-2195) vs 714 (511-1020) min, P = 0.0001] and ICU length of stay [70 (28-129) vs 26 (21-51) h, P = 0.0001], higher rate of ICU-acquired weakness (16.4% vs 5.3%, P = 0.015), reintubation (10.9% vs 1.3%, P = 0.005), dialysis (7% vs 0%, P = 0.005), delirium (36.4% vs 23.8%, P = 0.001) and mortality (3.6% vs 0.7%, P = 0.046).

Conclusion: Patients present frequently with AKI after cardiac surgery. EuroScore II, WBC count and chronic kidney disease are independent predictors of AKI development. The occurrence of AKI is associated with poor outcome.

Keywords: Acute kidney injury; Cardiac surgery; Outcome; Predisposing factors; Prognosis; Renal failure.