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

Abstract

BackgroundPostoperative 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.MethodsThis 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.ResultsA 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%.ConclusionsPerioperative BW change was independently associated with an increased risk for 30-day postoperative mortality in CS patients with RRT-requiring AKI.

Malnutrition screening and acute kidney injury in hospitalised patients: a retrospective study over a 5-year period from China

“…The sensitivity and specificity values for the NRS-2002 were 0•8 (0•76-0•84) and 0•89 (0•84-0•92), respectively, thus successfully identifying risk. Our results showed that both the NRS-2002 and AKI had a dose-response relationship between their severity and the adverse effect on the short-and long-term survival of the patients, which is consistent with previous studies (40,44,45) . Our finding suggests that both NRS-2002 scores ≥ 3 and AKI can worsen the short-and long-term prognosis of patients and the prognosis of the malnourished patient who develops AKI is far worse than that of the patient with normal nutritional status; thus, good nutritional support has been advocated in AKI.…”

Unsupervised clustering identifies sub-phenotypes and reveals novel outcome predictors in patients with dialysis-requiring sepsis-associated acute kidney injury

“…It has been reported that hyperlactatemia is an independent mortality predictor in patients with SA-AKI in the emergency department [ 50 ], postoperative AKI requiring RRT[29] and SA-AKI requiring CRRT [ 9 ]. However, other studies have shown that the initial lactate level is not independently associated with death in patients with SA-AKI requiring CRRT [ 10 , 51 ] or post-cardiovascular surgery AKI [ 32 ]. Moreover, in the literature, serum lactate has never been reported as an independent predictor of kidney recovery after AKI [ 6 , 29 , 52 , 53 ].…”

The Death Risk Factors of Patients Undergoing Re-Exploration For Bleeding or Tamponade After Isolate Off-Pump Coronary Artery Bypass Grafting: A Case-Control Study

“…Renal injury is a common yet potentially serious complication after cardiac surgery and its pathophysiology is complex and multifactorial, which includes several factors such as exogenous and endogenous toxins, metabolic factors, ischemia-reperfusion injury, neurohormonal activation, embolization, hemodynamic alterations, along with in ammation and oxidative stress [11]. On the one hand, due to worse cardiac function or hypotension during the reoperation, the kidneys may suffer from ischemic damage.…”