Abstract 16705: Prevalence and Outcomes Among Hospitalized Patients With Covid-19 and Atrial Fibrillation or Flutter

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zaniar Ghazizadeh ◽  
Chad Gier ◽  
Avinainder Singh ◽  
Lina Vadlamani ◽  
Maxwell Eder ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Kidney Injury ◽  
Adverse Events ◽  
Cardiac Injury ◽  
Kidney Injury ◽  
Prior History ◽  
New Haven ◽  
History Of ◽  
Record Review

Introduction: The prevalence and outcomes of patients hospitalized with COVID-19 with atrial fibrillation and atrial flutter (AF/FL) remains unclear. Methods: The Yale Cardiovascular COVID Registry is a cohort study of adult patients >=18 years hospitalized with COVID-19 in the Yale New Haven Health System. Retrospective medical record review was performed on consecutive patients from the registry admitted between March and June 2020. We calculated the rates of prior and in-hospital AF/FL and evaluated the unadjusted rates of in-hospital adverse events for both groups; we then calculated the adjusted odds of adverse events using logistic regression. Results: Among 396 patients, the mean age was 68.2, 52.3% were men, 56.4% were Caucasian, 28.4% Black and 16.9% Hispanic. 15.7% of patients had prior history of AF/FL. 19.9% of patients had in-hospital AF/FL, 7.83% of which did not have a prior history of AF/FL. Patients with in-hospital AF/FL had significantly more CV complications compared to those without including cardiac injury (78.5% vs 42.7%, p=0.000), type 2 myocardial infarction (53.3 vs 30.3%, p=0.002), and heart failure (32.9% vs 9.2%, p=0.000). In-hospital AF/FL was associated with significantly worse outcomes related to COVID-19 including ICU survival (OR 0.22 [0.08-0.59], p=0.002), heart failure (5.19 [2.56-10.5], p=0.000), myocardial injury (OR 2.87 [1.49-5.49], p=0.001), acute kidney injury (OR 2.02 [1.09-3.74], p=0.027), dialysis (OR 4.07 [1.38-12.03], p=0.011) and hospice/death (OR 2.47 [1.35-4.53], p=0.004). Conclusion: AF/FL are common in patients hospitalized with COVID-19 and these patients had significantly worse outcomes, including lower odds of ICU survival and higher odds of heart failure, acute kidney injury, dialysis and hospice/death.

Predictors of Acute Kidney Injury Following Surgical Valve Replacement

2020 ◽  
Author(s):  
Khalid S. Ibrahim ◽  
Khalid A. Kheirallah ◽  
Fadia A. Mayyas ◽  
Nizar A. Alwaqfi
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Blood Transfusion ◽  
Valve Replacement ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Inotropic Support ◽  
History Of ◽  
Surgical Valve Replacement ◽  
Perioperative Blood Transfusion

Abstract Background Acute kidney injury is a serious complication after surgical valve replacement and holds increased mortality rates. Objectives To study predictors of acute kidney injury after surgical valve replacement. Materials and Methods Patients who underwent valve surgery procedures at our center were included. Procedures included aortic valve replacement (AVR), mitral valve replacement (MVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with/without CABG. Results A total of 346 patients were included. The mean age was 51.56 (16.1). Males (n = 178) comprised 51%.At the univariate level analysis, predictors of acute kidney injury were found including age, ejection fraction, hypertension, history of CAD, emergency surgery, recent myocardial infarction, diabetes, atrial fibrillation, history of heart failure, mitral regurgitation (MR), pump time >120 minutes, aortic cross clamp >90 minutes, perioperative blood transfusion, re-exploration for bleeding, use of mechanical and biologic valve in aortic position, use of biologic valve in mitral position, prolonged inotropic support, postoperative stroke, and use of angiotensin converting enzyme inhibitors (ACEi) < a month, (all p < 0.05).By Logistic regression analysis, Age (p < 0.0001, odds ratio[AOR] = 1.076), hypertension (p = 0.039, AOR = 1.829), heart failure (p = 0.019, AOR = 2.448), MR (p = 0.0001, AOR = 3.110), use of ACEi <month (p = 0.043, AOR= 2.181), pump time >120 minutes (p = 0.022, AOR = 1.797), perioperative blood transfusion (p = 0.008, AOR = 2.532), and prolonged inotropic support (p = 0.012, AOR = 2.591) were significant and independent predictors of AKI. Conclusion Independent predictors of acute kidney injury following valve surgeries include age, hypertension, heart failure, MR, use of ACEi <month, perioperative blood transfusion, and prolonged pump time or inotropic support.

scholarly journals Device-detected atrial fibrillation before and after acute cardiac events: insights from ASSERT

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
WF Mcintyre ◽  
J Wang ◽  
EP Belley-Cote ◽  
JD Roberts ◽  
AP Benz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Event ◽  
Hypertensive Crisis ◽  
Cardiac Injury ◽  
Coronary Intervention ◽  
Prior History ◽  
Cardiac Events ◽  
Funding Sources ◽  
Before And After ◽  
History Of

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) that is first detected concurrently with or shortly after another cardiac event is often thought to be caused by acute cardiac injury, and therefore reversible. Methods ASSERT enrolled patients &gt;65 years old with hypertension and a pacemaker, but without known AF. We evaluated participants who had a cardiac event [angina/myocardial infarction (MI), cardiac catheterization/percutaneous coronary intervention (PCI), cardiac surgery or other (e.g. pericarditis, hypertensive crisis)] and compared the prevalence of device-detected AF before and after these events. Results Among 2580 participants, 178 (6.9%) had at least one cardiac event over a mean 2.5 years of follow-up. In the 30 days following a first cardiac event, the prevalence of device-detected AF &gt;6 min was 12.4% (95% confidence interval [CI] 7.9%-18.1%), which was higher than in the 30 days before the event (12.4% versus 4.5%, P = 0.004) (Figure 1). The prevalence of device-detected AF following the event was comparable across event subtypes (MI: 13.8%, 95%CI 7.9-18.1%; PCI: 6.9%, 95%CI 1.9-16.7%; Surgery: 20.0%, 95%CI 5.7-43.7%; Other: 18.5%, 95%CI 6.3-38.1%). There was a significant association between device-detected AF in the 6 months before a cardiac event and device-detected AF in the 30 days after a cardiac event: odds ratio (OR, adjusted for CHA2DS2-VASc score) for episodes &gt;6 min 7.07 (95%CI 2.07-24.19; P = 0.002); adjusted OR for episodes &gt;24 hours: 11.41 (95%CI 1.47-88.43; p = 0.020). Conclusions Acute cardiac events are associated with an increase in the prevalence of device-detected AF. These episodes are associated with a prior history of device-detected AF. Abstract Figure 1

Effect of acute kidney injury on hospital-based outcomes in patients with multiple myeloma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e20006-e20006
Author(s):  
Muhammad Usman Zafar ◽  
Zahid Tarar ◽  
Ghulam Ghous ◽  
Umer Farooq ◽  
Bradley Walter Lash
Keyword(s):  
Heart Failure ◽  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Teaching Hospitals ◽  
Inpatient Mortality ◽  
History Of

e20006 Background: Multiple Myeloma, a cancer of plasma cells, is treatable, but incurable. 5-year survival rate is about 54% depending upon the stage. Studies have suggested that up to 50% of the patients experience acute kidney injury or chronic kidney disease at some point in their disease course. Approximately 3% of the patients will end up on hemodialysis. In this study we utilize the National Inpatient Sample (NIS) to understand the effect of acute kidney injury (AKI) on inpatient mortality in multiple myeloma patients. Methods: This is a retrospective study utilizing the data obtained from the NIS for the year 2018. We queried this NIS database for ICD-10 codes for multiple myeloma or plasmacytoma that had not achieved remission or was in relapse. We also looked at codes for acute kidney injury as secondary diagnosis. Primary outcome was inpatient mortality. Secondary outcomes were hospital length of stay and cost utilization. We then ran multivariate logistic regression analysis in STATA MP 16.1. Various comorbidities were accounted for by adding them into the analysis. These included previous history of coronary artery disease, congestive heart failure, stroke, smoking, hyperlipidemia, stem cell transplant, neutropenia and chemotherapy. Results: The population of multiple myeloma patients under investigation were all adults more than 18 years of age and numbered in 3944 patients. The mean age was 65.71 years. Among these 45% were females. While examining inpatient mortality we see that for patients that had AKI the odds of inpatient mortality are higher (Odds Ratio (OR) 1.75, p = 0.003, 95% Confidence Interval (CI) 1.21 – 2.56). History of Heart Failure (OR 2.28, 95% CI 1.59 – 3.28), and increasing age (OR 1.02, 95% CI 1.01 – 1.04) also appear to contribute towards higher odds of mortality. The effect of other comorbidities was not statistically significant. Among demographical characteristics being of Native American heritage or not belonging to any descriptive race predicted higher odds of mortality. Mean LOS was 11 days. Patients with AKI stayed in the hospital longer by ̃1.4 days (Coef. 1.39, 95% CI 0.41 – 2.37). LOS was higher in patients with a history of heart failure (2.61, 95% CI 0.89 – 4.34 and in those with a history of neutropenia (5.52, 95% CI 4.42 – 6.62). LOS was lower in patients with a history of smoking by 1 day. Age lowered the LOS by a clinically insignificant amount. Teaching hospitals had higher LOS by ̃4 days. The total charge for hospitalizations from AKI is higher by $31019 (95% CI 14444.23 – 47594.37). Other factors incurring higher cost include history of neutropenia, and teaching hospitals. Hospitals in the Midwest had lower cost compared to hospitals in the Northeast. Conclusions: Among patients that present with a principal diagnosis of multiple myeloma, having acute kidney injury, adversely affects inpatient outcomes that include, mortality, hospital length of stay and total hospitalization cost.

Risk Factors for Cardiac Toxicities Associated with Proteasome Inhibitor Chemotherapy during Treatment of Multiple Myeloma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5363-5363
Author(s):  
John H. Chen ◽  
Daniel J. Lenihan ◽  
Sharon E. Phillips ◽  
Madan H. Jagasia ◽  
Stacey A. Goodman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Adverse Events ◽  
Cumulative Incidence ◽  
Male Gender ◽  
Prior History ◽  
Cardiac Events ◽  
History Of ◽  
Ascvd Risk ◽  
Cardiac Adverse Events

Abstract Introduction Proteasome inhibitors (PI) bortezomib (B) and carfilzomib (C) are cornerstone therapies for multiple myeloma (MM). An increased incidence of PI-induced cardiac adverse events (CAEs) has been reported in patients receiving C. However, risk factors for cardiac toxicity in this population remain unclear. Our objective is to evaluate the incidence of CAEs associated with C compared with B and identify risk factors for developing events. Patients and Method This was a retrospective analysis of 96 consecutive patients treated for MM at Vanderbilt University from 2011 to 2014 who received B (n=44) and/or C (n=52). Patients in the C group had been previously treated with B, whereas patients in the B group did not have exposure to C. No patients studied were included in both cohorts. We evaluated the clinical features and frequency of CAEs (grade II-IV heart failure, acute coronary syndrome, left ventricular dysfunction, atrial fibrillation/flutter, thromboembolism, systemic hypertension, pulmonary hypertension, orthostatic hypotension, or sudden cardiac death). To identify factors that predisposed patients to CAEs, we analyzed duration of PI therapy, 10-year atherosclerotic cardiovascular disease (ASCVD) risk (calculated risk of myocardial infarction or stroke), gender, use of antithrombotic (antiplatelet/anticoagulant) and antihypertensive medications, prior history of cardiac events, and disease cytogenetic profile. Patients with a prior history of cardiac events were followed by a cardio-oncologist during the course of treatment. Results Table 1 shows patient characteristics. Twenty-five patients experienced CAEs (B, 13% (n=12); C, 25% (n=13)). Cumulative incidence (CI) of CAEs was not significantly different in patients on C compared with B (log-rank test P = 0.41) (Figure 1). Heart failure was the most common type of CAE (Table 2). CAEs occurred after a median of 90 days (range, 4-456) with C and 63.5 days (range, 5-336) with B. By univariate analysis, more patients in the C group were prior smokers, underwent stem cell transplantation and had more prior lines of therapy. More patients in the B group used antithrombotic and ACE inhibitor agents. There were no other significant differences in the use of antihypertensive, antiarrhythmic, and lipid-lowering medications between cohorts. Multivariate analysis showed that male gender (HR 5.3, 95% CI 1.5-18.0, P = 0.007) was an independent risk factor for developing CAEs. Patients taking antithrombotic agents had a lower risk of CAE compared with those not on these therapies (HR 0.1, 95% CI 0.04-0.54, P = 0.004). While ASCVD risk was not predictive of CAEs, patients with a prior history of cardiac events who were followed by a cardio-oncologist experienced fewer CAEs (HR 0.2, 95% CI 0.05-0.72, P = 0.014). Longer duration of PI use resulted in decreasing risk of CAE (HR 0.8, 95% CI 0.7-0.9, P = 0.010). There were no interactions between these outcomes. Conclusions In this series, the incidence of CAEs associated with C did not differ significantly from that of B. We found that events occurred early in therapy. Male gender was an independent risk factor for CAEs. Use of antithrombotic therapy was associated with significantly reduced risk of CAEs. These data suggest that patients may benefit from antithrombotic therapy and follow-up by a cardio-oncologist while on PI therapy, particularly if there is a prior history of cardiac events. Table 1. Bortezomib % (n=44) Carfilzomib % (n=52) P-value ASCVD Risk 0.43 0-10% 46 50 10-20% 29 36 >20% 26 14 Male Gender 57 71 0.82 Median Age, y 61 (38-91) 60 (36-86) 0.20 Past Smoker 26 51 0.02 Type II Diabetes 11 17 0.41 Hyperlipidemia 27 27 0.97 Kidney Disease 9 12 0.70 Prior History of Cardiac Event 59 60 0.96 Median Duration on Bortezomib, d 229 203 0.67 Median Duration on Carfilzomib, d 87.5 ACE Inhibitor Use 32 13 0.03 Antithrombotic Use 48 23 0.01 ISS Stage 0.72 III 34 25 FISH Risk 0.13 Standard/Intermediate 93 85 High 7 15 Median Prior Lines of Therapy 0 (0-4) 2 (0-8) <0.001 Stem Cell Transplant 45 65 0.05 Table 2. Cardiac adverse events Bortezomib Carfilzomib P-value Total Cardiac Adverse Events* 19 17 0.08 Heart Failure 9 6 Acute Coronary Syndrome 1 2 Left Ventricular Dysfunction 0 1 Atrial Fibrillation/Flutter 2 2 Thromboembolism 2 2 Systemic Hypertension 3 3 Pulmonary Hypertension 0 1 Orthostatic Hypotension 2 0 Sudden Cardiac Death 0 0 *Some patients had multiple events Figure 1. Cumulative incidence of cardiac adverse events Figure 1. Cumulative incidence of cardiac adverse events Disclosures No relevant conflicts of interest to declare.

scholarly journals Cardiovascular adverse events in patients with chronic lymphocytic leukemia receiving acalabrutinib monotherapy: pooled analysis of 762 patients

Haematologica ◽  
2021 ◽  
Author(s):  
Jennifer R. Brown ◽  
John C. Byrd ◽  
Paolo Ghia ◽  
Jeff P. Sharman ◽  
Peter Hillmen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Lymphocytic Leukemia ◽  
Adverse Events ◽  
Pooled Analysis ◽  
Lymphocytic Leukemia ◽  
Prior History ◽  
History Of ◽  
Btk Inhibitor ◽  
Low Incidence ◽  
Grade 3

Cardiovascular (CV) toxicities of the Bruton tyrosine kinase (BTK) inhibitor ibrutinib may limit use of this effective therapy in patients with chronic lymphocytic leukemia (CLL). Acalabrutinib is a second-generation BTK inhibitor with greater BTK selectivity. This analysis characterizes pooled CV adverse events (AEs) data in patients with CLL who received acalabrutinib monotherapy in clinical trials (NCT02029443; NCT02475681; NCT02970318; NCT02337829). Acalabrutinib was given orally at total daily doses of 100–400 mg, later switched to 100 mg twice daily, and continued until disease progression or toxicity. Data from 762 patients (median age: 67 years [range, 32–89]; median follow-up: 25.9 months [range, 0–58.5]) were analyzed. Cardiac AEs of any grade were reported in 129 patients (17%; grade ≥3, n=37 [5%]) and led to treatment discontinuation in 7 patients (1%). The most common any-grade cardiac AEs were atrial fibrillation/flutter (5%), palpitations (3%), and tachycardia (2%). Overall, 91% of patients with cardiac AEs had CV risk factors before acalabrutinib treatment. Among 38 patients with atrial fibrillation/flutter events, 7 (18%) had prior history of arrhythmia or atrial fibrillation/flutter. Hypertension AEs were reported in 67 patients (9%), 43 (64%) of whom had a preexisting history of hypertension; no patients discontinued treatment due to hypertension. No sudden cardiac deaths were reported. Overall, these data demonstrate a low incidence of new-onset cardiac AEs with acalabrutinib in patients with CLL. Findings from the head-to-head, randomized trial of ibrutinib and acalabrutinib in patients with high-risk CLL (NCT02477696) will prospectively assess differences in CV toxicity between the two agents.

P1575Cardiovascular toxicity following modern multiple myeloma therapy in Japanese cohort

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Shibata ◽  
S Nohara ◽  
K Nagafuji ◽  
Y Fukumoto
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Multiple Myeloma ◽  
Troponin I ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prior History ◽  
Ventricular Ejection Fraction ◽  
Increased Risk ◽  
History Of

Abstract Background Multiple myeloma (MM) is a plasma cell dyscrasia accounting for approximately 13% of hematologic malignancies. Patients with MM have an increased risk of cardiovascular adverse events (CAEs) due to disease burden and/or anti-myeloma treatment-related risk factors. However, little is known about the incidence of cardiovascular toxicity of patients with MM. Methods We analyzed 42 consecutive patients (Male/Female 22/20, age 67±10 years old) who received anti-MM therapies between October 2016 and September 2018 from our University Cardio-REnal Oncology (CREO) registry. We examined the incidence of CAEs through January 2019 including congestive heart failure and cardiomyopathy (CHF/CM), ischemic cardiac event, newly symptomatic arrhythmias included atrial fibrillation or flutter requiring treatment, and venous thromboembolism (VTE). Results Within the 408-day median follow-up period (range 15–844 days), CAEs occurred in 23.8% (n=10); CHF/CM in 11.9%, newly diagnosed atrial fibrillation in 4.8%, VTE in 4.8%, vasospastic angina in 2.4%, and death in 28.6%. There were no significant differences between CAEs group and non-CAEs group in terms of sex, body mass index (BMI), incidence of hypertension, ischemic heart disease, prior history of heart failure, cardiovascular medications, left ventricular ejection fraction, serum high-sensitivity troponin-I, estimated glomerular filtration rate, blood urea nitrogen and N-terminal pro-brain natriuretic peptide levels at the time of enrollment. The use of various types of proteasome inhibitors and immunomodulatory drugs were not associated with the increased risk of CAEs. By multivariate analysis, a history of prior anti-myeloma therapies was identified as an independent risk factor for CAEs. Conclusion CAEs were significantly associated with the recurrent MM in Japanese MM patients.

Trends in complications and mortality following catheter ablation of atrial fibrillation: results from 22,582 ablations in Australia and New Zealand from 2010 to 2015

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Ngo ◽  
A Ali ◽  
A Ganesan ◽  
R Woodman ◽  
A McGavigan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Venous Thromboembolism ◽  
Catheter Ablation ◽  
Kidney Injury ◽  
Funding Source ◽  
Complications And Mortality ◽  
Over Time

Abstract Background Recent studies from the United States report rising rates of in-hospital complications and mortality following catheter ablation of atrial fibrillation (AF) but whether such a trend is observed in other populations is uncertain. Purpose To examine the trends in complications and mortality following AF ablations up to 30 days after discharge in Australia and New Zealand (ANZ) using nationwide data. Methods All patients ≥18y undergoing catheter ablation of AF from 2010–2015 were identified using hospitalisation data from all public and most private hospitals in ANZ. The primary endpoint was one or more procedural complications during the hospital stay or within 30 days of discharge. The secondary endpoints were mortality and other specific complications. Unadjusted trend was evaluated using Cochran-Armitage test while that of complications, adjusting for differences in other characteristics, was evaluated using multivariate logistic regression with the year of ablation modelled as a continuous variable. Results are reported as odd ratios (OR) and 95% confidence intervals (CI). Results A total of 22,582 AF ablations were included (mean age 62.2±11.6y, 29.1% female, 94.4% elective procedures). The number of ablations increased by 26.4% during the study period (3,097 in 2010 to 3,915 in 2015). Rates of heart failure (8.98% to 10.09%, p for trend=0.010), diabetes (4.52% to 12.46%, p&lt;0.001), chronic kidney disease (2.36% to 4.29%, p&lt;0.001) significantly increased over time but that of hypertension decreased (15.27% to 12.29%, p&lt;0.001). The incidence of overall complications (6.55% in 2010 to 6.67% in 2015, OR 0.99, 95% CI 0.96–1.03) was unchanged during the study period (Figure 1A). When individual complications were considered, mortality rate was low with no statistically significant change with time (0.19% to 0.15%, OR 1.03, 95% CI 0.84–1.28) (Figure 1A) while the rate of acute kidney injury (0.23% to 0.51%, OR 1.17, 95% CI 1.02–1.34) increased and that of venous thromboembolism (0.16% to 0.0%, OR 0.71, 95% CI 0.54–0.94) decreased (Figure 1B). Though the incidence of any bleeding (4.49% to 3.98%, OR 0.97, 95% CI 0.93–1.01) was unchanged, that of major bleeding requiring blood transfusion (0.97% to 0.64%, OR 0.87, 95% CI 0.79–0.96) declined significantly (Figure 1B). No significant trend was observed in other complications or when in-hospital (5.13% to 5.21%, OR 1.00, 95% CI 0.97–1.04) and post-discharge (1.55% to 1.63%, OR 0.97, 95% CI 0.91–1.03) complications were separately evaluated. Conclusions Though more patients with heart failure, diabetes and chronic kidney disease underwent catheter ablation of AF over time in ANZ, the overall complication rate was unchanged with a significant decrease in the incidences of major bleeding and venous thromboembolism. However, rate of acute kidney injury nearly doubled, and this could be a potential target for efforts to further improve procedural safety. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The National Heart Foundation of Australia

Abstract 18018: Clinical Predictors of Acute Kidney Injury After Lower Extremity Surgical Bypass in the Society for Vascular Surgery Vascular Quality Initiative

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Erica Flores ◽  
Ke Chen ◽  
Juan Pablo Lewinger ◽  
Leonardo Clavijo ◽  
David Shavelle ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Blood Transfusion ◽  
Lower Extremity ◽  
Emergency Surgery ◽  
Multivariate Logistic Regression Analysis ◽  
Kidney Injury ◽  
Clinical Predictors ◽  
Factors Associated ◽  
History Of

Introduction: The incidence and factors associated with acute kidney injury (AKI) development after lower extremity bypass (LEB) are not well defined. The objective of this study is to determine the incidence and characteristics associated with the development of AKI in patients undergoing infrainguinal LEB. Methods: A retrospective review of all LEB surgeries in the Vascular Quality Initiative (VQI) registry from January 2003 to April 2015 was performed. AKI was defined as post-operative rise in creatinine (Cr) > 0.5 mg/dl or new renal impairment requiring dialysis. Demographic, procedural and clinical variables were collected. Patients on dialysis and those missing pre and post-operative Cr values were excluded. Multivariate logistic regression analysis was performed to identify variables associated with the development of AKI following LEB. Results: 12,564 patients were included in the analysis; 509 (4%) developed AKI. Comparison of baseline characteristics between patients that developed AKI and those that did not are shown in the Table. In multivariate analysis, diabetes (OR 1.57, p<0.01), history of heart failure (OR 1.60, p<0.01), emergency surgery (OR 1.34, p<0.01), need for blood transfusion (OR 2.41, p<0.01) and chronic kidney disease (CKD) stages 2 (OR 1.39, p<0.01), 3(OR 2.85, p<0.01), and 4(OR 5.46, p<0.01) were all significantly associated with AKI. Factors associated with a lower incidence of AKI included smoking (OR 0.72, p<0.05), female gender (OR 0.69, p<0.01) and higher hemoglobin levels (OR 0.92, p<0.01). Conclusions: Overall, the development of AKI in a large contemporary database was 4%. Multiple clinical characteristics are associated with development of AKI, including history of heart failure, diabetes, CKD, emergency surgery and need for blood transfusion, and may help to identify at-risk patients. Further studies are needed to prospectively validate these findings and determine if postoperative AKI increases the mortality risk.

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