Associated Factors And Short-Term Mortality Of Early versus Late Acute Kidney Injury Following on-pump Cardiac Surgery

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Interact Cardiovasc Thorac Surg. 2022 May 16:ivac118. doi: 10.1093/icvts/ivac118. Online ahead of print.


OBJECTIVES: Acute kidney injury (AKI) is common following cardiac surgery. The aimed was to investigate characteristics of AKI occurred within 48 hours and during 48 hours to 7 days after cardiac surgery.

METHODS: Patient data was extracted from Medical Information Mart for Intensive Care III (MIMIC III) database. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) guideline, and divided into early (within 48 hours) and late (during 48 hours to 7 days) AKI. Multivariable logistic regression models were established to investigate risk factors for AKI. Cox proportional hazards model was used to analyze 90-day survival.

RESULTS: AKI occurred in 51.2% (2741/5356) patients within the first 7 days following cardiac surgery, with the peak occurrence at 36-48 hours. Incidence of early and late AKI were 41.9% and 9.2%, respectively. Patients with late AKI were older and had more comorbidities compared to early AKI patients. Risk factors associated with early AKI included age, body mass index (BMI), congestive heart failure, diabetes. While late AKI was related to atrial fibrillation, estimated glomerular filtration rate (eGFR), sepsis, norepinephrine, mechanical ventilation, packed red blood cell transfusion. In Cox proportional model, both late and early AKI were independently associated with 90-day mortality, and patients with early AKI had better survival than those with late AKI.

CONCLUSIONS: AKI occurred earlier was distinguishable from AKI occurred later after cardiac surgery. Time frame should be taken into consideration.

PMID:35575352 | DOI:10.1093/icvts/ivac118