Post-operative acute kidney injury and five-year risk of death, myocardial infarction, and stroke among elective cardiac surgical patients: a cohort study
| Autor: | Malene Kærslund Hansen, Vibeke E. Hjortdal, Martin Majlund Mikkelsen, Christian Fynbo Christiansen, Søren Paaske Johnsen, James Bradley Layton, Henrik Gammelager |
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| Jazyk: | angličtina |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Arthroplasty Replacement Hip Population urologic and male genital diseases Critical Care and Intensive Care Medicine Risk Factors Internal medicine medicine Humans Cumulative incidence cardiovascular diseases Renal replacement therapy Myocardial infarction Renal Insufficiency Chronic education Stroke Cause of death Retrospective Studies education.field_of_study urogenital system business.industry Research Acute kidney injury Acute Kidney Injury medicine.disease female genital diseases and pregnancy complications Elective Surgical Procedures cardiovascular system Cardiology business Kidney disease |
| Zdroj: | Critical Care Hansen, M K, Gammelager, H, Mikkelsen, M M, Hjortdal, V E, Layton, J B, Johnsen, S P & Christiansen, C F 2013, ' Post-operative acute kidney injury and five-year risk of death, myocardial infarction, and stroke among elective cardiac surgical patients : a cohort study ', Critical Care (Online Edition), vol. 17, no. 6, pp. R292 . https://doi.org/10.1186/cc13158 |
| ISSN: | 1364-8535 |
| DOI: | 10.1186/cc13158 |
| Popis: | Introduction The prognostic impact of acute kidney injury (AKI) on long-term clinical outcomes remains controversial. We examined the five-year risk of death, myocardial infarction, and stroke after elective cardiac surgery complicated by AKI. Methods We conducted a cohort study among adult elective cardiac surgical patients without severe chronic kidney disease and/or previous heart or renal transplant surgery using data from population-based registries. AKI was defined by the Acute Kidney Injury Network (AKIN) criteria as a 50% increase in serum creatinine from baseline level, acute creatinine rise of ≥26.5 μmol/L (0.3 mg/dL) within 48 hours, and/or initiation of renal replacement therapy within five days after surgery. We followed patients from the fifth post-operative day until myocardial infarction, stroke or death within five years. Five-year risk was computed by the cumulative incidence method and compared with hazards ratios (HR) from a Cox proportional hazards regression model adjusting for propensity score. Results A total of 287 (27.9%) of 1,030 patients developed AKI. Five-year risk of death was 26.5% (95% CI: 21.2 to 32.0) among patients with AKI and 12.1% (95% CI: 10.0 to 14.7) among patients without AKI. The corresponding adjusted HR of death was 1.6 (95% CI: 1.1 to 2.2). Five-year risk of myocardial infarction was 5.0% (95% CI: 2.9 to 8.1) among patients with AKI and 3.3% (95% CI: 2.1 to 4.8) among patients without AKI. Five-year risk of stroke was 5.0% (95% CI: 2.8 to 7.9) among patients with AKI and 4.2% (95% CI: 2.9 to 5.8) among patients without AKI. Adjusted HRs were 1.5 (95% CI: 0.7 to 3.2) of myocardial infarction and 0.9 (95% CI: 0.5 to 1.8) of stroke. Conclusions AKI, within five days after elective cardiac surgery, was associated with increased five-year mortality and a statistically insignificant increased risk of myocardial infarction. No association was seen with the risk of stroke. |
| Databáze: | OpenAIRE |
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