Abstract
Background: Patients who develop postoperative acute kidney injury (AKI) have a poor prognosis, especially when undergoing high-risk surgery. Therefore, the objective of this study was to evaluate the outcome of patients with AKI acquired after noncardiac surgery and the possible risk factors for this complication. Methods: A multicenter, prospective cohort study with patients admitted to intensive care units (ICUs) after noncardiac surgery was conducted to assess whether they developed AKI. The outcomes of patients who developed AKI were then compared to those of patients who did not develop it. Results: A total of 29 ICUs participated, of which 904 involved high-risk surgical patients who were included in the study. The occurrence of AKI in the postoperative period was 15.8%, and the mortality rate of postoperative AKI patients at 28 days was 27.6%. AKI was strongly associated with 28-day mortality (OR = 2.91; 95% CI 1.51-5.62; P= 0.001), and higher length of ICU stay (P< 0.001), length of hospital stay (P<0.001) and length of mechanical ventilator stay (P<0.001). Independent factors for the risk of developing AKI were preoperative anemia (OR=7.0; P= 0.001), SAPS 3 ( OR= 1.04, P<0.001), postoperative vasopressor use (OR= 2.47; P<0.001), postoperative infection (OR= 8.8; P<0.001), need for reoperation (OR= 7.1; P<0.001) and elective surgery (OR= 0.4; P<0.001) was protective for AKI. In addition, patients with higher perioperative fluid balance had more chance for AKI.Conclusions: AKI is associated with risk of death. Patients with anemia prior to surgery, who had a higher SAPS 3, needed a postoperative vasopressor or had postoperative infection or needed reoperation were more likely to develop AKI, as were those with a higher perioperative fluid balance.
Role of Acute Kidney Injury in High-Risk Surgical Patients. A Multicenter Prospective Cohort Study.
