Perioperative Hemodynamic Instability and Fluid Overload are Associated with Increasing Acute Kidney Injury Severity and Worse Outcome after Cardiac Surgery
| Autor: | Anja Haase-Fielitz, Paolo Calzavacca, Anke Spura, Michael Haase, Christian Albert, Ingo Kutschka, Hassina Baraki, Rinaldo Bellomo |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Critical Care medicine.medical_treatment Water-Electrolyte Imbalance Hemodynamics Renal function 030204 cardiovascular system & hematology Kidney Function Tests urologic and male genital diseases Severity of Illness Index 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors Internal medicine Severity of illness medicine Humans Hospital Mortality Renal replacement therapy Cardiac Surgical Procedures Perioperative Period Aged Aged 80 and over business.industry Acute kidney injury Disease Management 030208 emergency & critical care medicine Hematology General Medicine Perioperative Acute Kidney Injury Middle Aged Prognosis medicine.disease Body Fluids Cardiac surgery Patient Outcome Assessment Renal Replacement Therapy Nephrology Area Under Curve Cardiology Female business Hemodynamic instability |
| Zdroj: | Blood Purification. 43:298-308 |
| ISSN: | 1421-9735 0253-5068 |
| DOI: | 10.1159/000455061 |
| Popis: | Purpose: The study aimed to investigate patients' characteristics, fluid and hemodynamic management, and outcomes according to the severity of cardiac surgery-associated acute kidney injury (CSA-AKI). Methods: In a single-center, prospective cohort study, we enrolled 282 adult cardiac surgical patients. In a secondary analysis, we assessed preoperative patients' characteristics, physiological variables, and medication for intra- and postoperative fluid and hemodynamic management and outcomes according to CSA-AKI stages by the Renal risk, Injury, Failure, Loss, End-stage renal disease (RIFLE) classification. Variables of fluid and hemodynamic management were further assessed with regard to the need for postoperative renal replacement therapy (RRT) and in-hospital mortality by the area under the curve for the receiver operating characteristic (AUC-ROC) and multivariate regression analysis. Results: Patients with worsening RIFLE stage, were significantly older, had lower estimated glomerular filtration rate and higher body mass index, more peripheral vascular and chronic obstructive pulmonary disease, atrial fibrillation, and prolonged duration of cardiopulmonary bypass (all p < 0.01). Patients with more severe AKI stage stayed longer in the intensive care and hospital, had higher in-hospital mortality, and requirement for RRT (all p < 0.001). Also, with worsening RIFLE stage, patients had lower intraoperative mean arterial pressure (MAP); p = 0.047, despite higher doses of norepinephrine (p < 0.001). The intraoperative MAP showed the best discriminatory ability (AUC-ROC: >0.8) for and was independently associated with RRT and in-hospital mortality. Moreover, with increasing AKI severity, patients received significantly more fluid infusion, and required higher dose of furosemide; nonetheless, they had increased postoperative fluid balance. Conclusions: In this cohort, reduced MAP and increased fluid balance were independently associated with increased mortality and need for RRT after cardiac surgery. |
| Databáze: | OpenAIRE |
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