Background Intraoperative hypotension is a risk factor for postoperative acute kidney injury (AKI). Elderly patients are susceptible due to reduced responses to acute hemodynamic changes. Aims Determine the association between hypotension identified from anesthetic charts and postoperative AKI in elderly patients. Methods Retrospective cohort study of elective noncardiac surgery patients ≥65 years, at an Australian tertiary hospital (December 2019–March 2021), with the primary outcome of AKI ≤48 h of surgery. Factors of interest were intraoperative hypotension determined from anesthetic charts (mean arterial pressure <60 mmHg, systolic blood pressure <90 mmHg, recorded 5-min) and intraoperative vasopressor use. Results In 830 patients (mean age 75 years), systolic hypotension was more frequent than mean arterial hypotension (25.7% vs. 11.9%). Most hypotensive episodes were brief (7.2% of systolic and 4.2% of mean arterial hypotension lasted >10 min) but vasopressors were used in 84.7% of cases. The incidence of postoperative AKI was 13.9%. Systolic hypotension >20 min was associated with AKI (OR, 3.88; 95% CI: 1.38–10.9), which was not significant after adjusting for vasopressors, creatinine, American Society of Anesthesiologists class, and hemoglobin drop. The cumulative dose of any specific vasopressor >20 mg (or >10 mg epinephrine) was independently associated with AKI (adjusted OR, 2.47; 95% CI: 1.34–4.58). Every 5 mg increase in the total dose of all intraoperative vasopressors used during surgery was associated with 11% increased odds of AKI (95% CI: 3–19%). Conclusions High vasopressor use was associated with postoperative AKI in elderly patients undergoing noncardiac surgery, independent of hypotension identified from anesthetic charts.

Hyponatremia may be a risk factor for rhabdomyolysis, but the association is not well defined and may be confounded by other variables. The aims of this study were to determine the prevalence and strength of the association between hyponatremia and rhabdomyolysis and to profile patients with hyponatremia. In a cross-sectional study of 870 adults admitted to hospital with rhabdomyolysis and a median peak creatine kinase of 4064 U/L (interquartile range, 1921–12,002 U/L), glucose-corrected serum sodium levels at presentation showed a U-shape relationship to log peak creatine kinase. The prevalence of mild (130–134 mmol/L), moderate (125–129 mmol/L), and severe (<125 mmol/L) hyponatremia was 9.4%, 2.5%, and 2.1%, respectively. We excluded patients with hypernatremia and used multivariable linear regression for analysis (n = 809). Using normal Na+ (135–145 mmol/L) as the reference category, we estimated that a drop in Na+ moving from one Na+ category to the next was associated with a 25% higher creatine kinase after adjusting for age, alcohol, illicit drugs, diabetes, and psychotic disorders. Multifactorial causes of rhabdomyolysis were more common than single causes. The prevalence of psychotic and alcohol use disorders was higher in the study population compared to the general population, corresponding with greater exposure to psychotropic medications and illicit drugs associated with hyponatremia and rhabdomyolysis. In conclusion, we found an association between hyponatremia and the severity of rhabdomyolysis, even after allowing for confounders.

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Background/Aims Patients with anti-neutrophil cytoplasmic antibody associated vasculitis (AAV) often have reduced health-related quality of life (HRQoL) as assessed by the SF-36 questionnaire. Global assessment provides a patient and physician’s view on the patient’s overall health and wellbeing. The aim of this project was to examine the level of agreement between the patient and physician global assessment (PtGA and PhGA) in patients with AAV. Methods Patients attending our dedicated tertiary vasculitis clinic were recruited into this prospective study. PtGA and PhGA scores, out of 100, were assessed via a visual analog scale, with higher scores representing better health. SF-36 assessed HRQoL. Discordance was defined as an absolute difference of ≥ 20 between PhGA and PtGA. Active disease was defined as a BVAS of ≥ 1. Results Ninety-seven patients (mean age 58 years, 46% male) participated. Forty-three (44%) patients had active disease. The majority (88%) were on immunosuppressive therapy with renal (79.4%), lung (42.3%) and sino-nasal (40.2%) being the most commonly involved systems. The mean (SD) PtGA and PhGA was 63.4 (22.2) and 60.8 (24.8) respectively (t = 2.63, p = 0.0049). Mean (SD) PtGA in active versus inactive disease was 59 (22.8) and 66 (21.5) respectively (t = 1.49, p = 0.07). PhGA scores were higher than PtGA in 44 patients with an overall mean difference of + 13.7 (95% confidence interval [CI] 9.97, 17.46, p &lt; 0.001). PtGA scores were higher than PhGA in 48 patients (mean difference +17.9, 95% CI 22.6, 13.3, p &lt; 0.001). Scores were discordant in 26 patients, with PhGA&gt;PtGA (negatively discordant) in 10 (38%). Mean (SD) PhGA in discordant patients versus non-discordant patients was 47.5 (24.7) versus 65.7 (23.1) respectively (t = 1.71, p = 0.001). Mean (SD) age in positively discordant versus negatively discordant patients was 58.8 (17.3) versus 69.1 (8) respectively (t = 1.71, p = 0.026). The percentage of patients with active disease (n=number of patients) in positively discordant versus negatively discordant patients was 50% (n = 8) versus 30% (n = 3) respectively (p = 0.008). Bland-Altman plots showed no systematic bias as global scores increased. Conclusion Overall, physicians did not overestimate patients' global health when using the global assessment tool. Discordance rates were 26%, within which physicians were likelier to assess the patient's global health as lower than patients did themselves. Positively discordant patients (PhGA&lt;PtGA) were likelier to have active disease and were younger on average. Disclosure A. Bhonsle: None. T. Coughlan: None. R. Graven: None. P. Bussa: None. M. Gingold: None. K. Polkinghorne: None. J. Ryan: None. A. Kitching: None.