The effects of acute kidney injury in a multicenter cohort of high-risk surgical patients

Abstract

Background and objectives Patients who develop post-operative acute kidney injury (AKI) have a poor prognosis, especially when undergoing high-risk surgery. Therefore, the objective of this study was to evaluate the outcome of patients with AKI acquired after non-cardiac surgery and the possible risk factors for this complication. Methods A multicenter, prospective cohort study with patients admitted to intensive care units (ICUs) after non-cardiac surgery was conducted to assess whether they developed AKI. The patients who developed AKI were then compared to non-AKI patients. Results A total of 29 ICUs participated, of which 904 high-risk surgical patients were involved in the study. The occurrence of AKI in the post-operative period was 15.8%, and the mortality rate of post-operative AKI patients at 28 days was 27.6%. AKI was strongly associated with 28-day mortality (OR = 2.91; 95% CI 1.51–5.62; p = 0.001), and a higher length of ICU and hospital stay ( p < 0.001). Independent factors for the risk of developing AKI were pre-operative anemia (OR = 7.01; 95% CI 1.69–29.07), elective surgery (OR = 0.45; 95% CI 0.21–0.97), SAPS 3 (OR = 1.04; 95% CI 1.02–1.06), post-operative vasopressor use (OR = 2.47; 95% CI 1.34–4.55), post-operative infection (OR = 8.82; 95% CI 2.43–32.05) and the need for reoperation (OR= 7.15; 95% CI 2.58–19.79). Conclusion AKI was associated with the risk of death in surgical patients and those with anemia before surgery, who had a higher SAPS 3, needed a post-operative vasopressor, or had a post-operative infection or needed reoperation were more likely to develop AKI post-operatively.

Trends in perioperative practices of high-risk surgical patients over a 10-year interval

“…As for the metabolic variables, higher creatinine in the immediate postoperative period was associated with mortality. Acute kidney injury (AKI) is a condition that reflects the context of patient severity within the ICU and is associated with worse outcomes and mortality [34]. It is no different in surgical patients, as has been the subject of recent studies that examined the correlation of poor prognosis with higher levels of acute kidney injury [35][36][37].…”

Effect of dexmedetomidine for prevention of acute kidney injury after cardiac surgery: an updated systematic review and meta-analysis

“…Acute kidney injury (AKI) is a serious complication of cardiac surgery with an estimated incidence of 20% [ 1 , 2 ]. It is the second most common type of AKI in the intensive care unit, following sepsis-related AKI [ 3 ].…”

Estudo da anemia como fator de risco e modificador de prognóstico de injúria renal aguda em pacientes internados em Unidade de Terapia Intensiva

“…Essa prevalência é maior que a relatada por Corwin et al (2004) O nosso estudo também evidenciou que anemia na admissão na UTI se associou à maior incidência de IRA, com aumento de 50% na chance de desenvolver IRA em relação aos pacientes sem anemia. Essa associação tem sido bastante estudada em pacientes submetidos a cirurgias cardíacas, e tem sido encontrada tanto com anemia pré-operatória, como na intraoperatória (Oprea et al 2018, Karkouti, 2015, Chen et al, 2020, Sickeler et al, 2014, Katayama et al, 2021. Fowler et al (2015) Chok et al (2009) ao submeterem um grupo de animais a um período de isquemia, com…”

“…com o desenvolvimentos de IRA, diagnosticada pelo KDIGO (OR 1,23; IC 95% 1,13 -1,33), não havendo relação com a anemia pós-operatória definida pela mediana dos valores mais baixos durante a internação na UTI (OR 1,01; IC 95% 0,89 -1,15) eKatayama et al (2021), em uma coorte prospectiva com 904 pacientes submetidos a cirurgias não cardíacas, em 29 (diagnosticada pelo KDIGO), com aumento de 1,8 vezes na chance de desenvolver IRA em comparação com indivíduos com Hb ≥10,5 g/dl. A associação maior que a observada no presente estudo pode ser decorrente do ponto de corte da Hb avaliada ser menor que o desse estudo (Hb ≤ 11 g/dl) Srisawat et al (2020).…”