Persistent AKI as Predictor of In-Hospital Mortality in Abdominal Surgery

Surgical patients frequently experience acute kidney injury (AKI). AKI is associated with adverse effects on both short-term and long-term outcomes. Ioana Gameiro, MD, and colleagues in Portugal conducted a study designed to examine the incidence and predictive factors of transient and persistent postoperative AKI in patients undergoing major abdominal surgery. The researchers also sought to characterize the impact of AKI on in-hospital mortality.

Results were reported online in a NKF 2020 Spring Clinical Meetings abstract. The abstract was titled Postoperative AKI Duration and Outcome in Patients Undergoing Major Abdominal Surgery.

The current study was a cross-examination of a retrospective analysis of clinical data of 450 patients who underwent major abdominal surgery form January 2010 to February 2011. The analysis included only AKI developing in the first 48 hours following surgery.

The Kidney Disease Improving Global Outcomes classification was used to define AKI based on both serum creatinine and urine output criteria. Persistent and transient AKI were defined using definitions from the Acute Disease Quality Initiative workgroup.

In the first 48 hours following surgery, 22.4% of patients developed AKI (n=101); of those, 48% (n=49) had persistent AKI, defined as postoperative AKI with a duration of more than 48 hours. Independent predictors of persistent AKI were older age (adjusted odds ratio [aOR], 1.06; 95% confidence interval [CI], 1.00-1.11; P=.039); hypertension (aOR, 4.60; 95% CI, 1.17-18.11; P=.029); and higher preoperative serum creatinine (aOR, 22.67; 95% CI, 4.00-128.46; P<.001).

Overall in-hospital mortality was 6.4% (n=29). There was an association between persistent AKI and higher mortality compared with transient AKI (51.9% vs 20.7%; unadjusted OR, 13.03, 95% CI, 5.78-29.36; P<.001; aOR, 4.20, 95% CI, 1.02-17.27, P=.047).

In summary, the researchers said, “In this cohort of patients submitted to major abdominal surgery, persistent AKI was an independent predictor of in-hospital mortality in contrast to transient AKI.”

Source: Gameiro I, Duarte I, Marques F, et al. Postoperative AKI duration and outcome in patients undergoing major abdominal surgery. Abstract of a presentation at the National Kidney Foundation 2020 Spring Clinical Meetings; abstract #3.