Acute Kidney Injury Severity and Long-Term Readmission and Mortality After Cardiac Surgery.

Autor:	Brown JR; Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire; Department of Medicine, Geisel School of Medicine, Lebanon, New Hampshire. Electronic address: jbrown@dartmouth.edu., Hisey WM; Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire., Marshall EJ; Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire., Likosky DS; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan., Nichols EL; Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire., Everett AD; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland., Pasquali SK; Department of Pediatrics and Communicable Diseases, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, Michigan., Jacobs ML; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland., Jacobs JP; Johns Hopkins All Children's Heart Institute, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Florida., Parikh CR; Department of Internal Medicine and Program of Applied Translational Research, Yale University School of Medicine, Temple Medical Center, New Haven, Connecticut.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2016 Nov; Vol. 102 (5), pp. 1482-1489. Date of Electronic Publication: 2016 Jun 17.
DOI:	10.1016/j.athoracsur.2016.04.020
Abstrakt:	Background: Acute kidney injury (AKI) is a common complication after cardiac surgery. While AKI severity is known to be associated with increased risk of short-term outcomes, its long-term impact is less well understood. Methods: Adult patients undergoing isolated coronary artery bypass graft surgery at eight centers were enrolled into the Northern New England biomarker registry (n = 1,610). Patients were excluded if they had renal failure (n = 15) or died during index admission (n = 38). Severity of AKI was defined using the Acute Kidney Injury Network (AKIN). We linked our cohort to national Medicare and state all-payer claims to ascertain readmissions and to the National Death Index to ascertain survival. Kaplan-Meier and multivariate Cox proportional hazards modeling was conducted for time to readmission and death over 5 years. Results: Within 5 years, 513 patients (33.8%) had AKI with AKIN stage 1 (29.9%) and stage 2 to 3 (3.9%). There were 620 readmissions (39.9%) and 370 deaths (23.8%). After adjustment, stage 1 AKI patients had a 31% increased risk of readmission (95% confidence interval [CI]: 1.10 to 1.57), whereas stage 2 or 3 patients had a 98% increased risk (95% CI: 1.41 to 2.78) compared with patients having no AKI. Relative to patients without AKI, stage 1 patients had a 56% increased risk of mortality (95% CI: 1.14 to 2.13), whereas stage 2 or 3 patients had a 3.5 times higher risk (95% CI: 2.16 to 5.60). Conclusions: Severity of AKI using the AKIN stage criteria is associated with a significantly increased risk of 5-year readmission and mortality. Our findings suggest that efforts to reduce AKI in the perioperative period may have a significant long-term impact on patients and payers in reducing mortality and health care utilization. (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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