scholarly journals Elevated preoperative D-dimer is associated with acute kidney injury after non-cardiac surgery

2021 ◽  
Author(s):  
Yan Zhou ◽  
Hong-Yun Yang
Keyword(s):  
Cardiac Surgery ◽  
Propensity Score ◽  
Odds Ratio ◽  
Additive Model ◽  
Kidney Injury ◽  
P Value ◽  
Propensity Score Weighting ◽  
Before And After ◽  
Postoperative Aki ◽  
D Dimer

Abstract aimed to analyze the relationship between preoperative D-dimer level and AKI following non-cardiac surgery.Method: This was a single-center retrospective cohort study for elective non-cardiac surgery from January 1, 2012, to December 31, 2018. The endpoint was the occurrence of AKI 7 days postoperatively in the hospital. The non-linear relationship was described using the generalized additive model. ROC and minimum P-value approach identified possible cut-off points. D-dimer's odds ratio as continuous, quantile, and dichotomous variables by various cut-off points for postoperative AKI were calculated in multivariate logistic regression models before and after propensity score weighting.Results: Of the 55439 surgery, 5.0% (2779 cases) suffered postoperative AKI. Non-linearity was found between D-dimer and postoperative AKI. The odds ratio for D-dimer before and after propensity score weighting was (≤ 0.380 µg/mL as reference, minimum P-value cut-off point) 1.35 (1.20-1.49), P < 0.001 and 1.25 (1.09-1.43), P = 0.001, respectively; (≤ 0.165 µg/mL as reference, ROC cut-off point) 1.24 (1.12-1.37), P < 0.001 and 1.18 (1.06-1.31), P = 0.002, respectively. Sensitivity analysis showed similar results. Heterogeneity subgroup analysis showed that patients with normal preoperative creatinine, hemoglobin level, and intraperitoneal surgery or more complex surgery seemed to be more vulnerable to elevated D-dimer.Conclusions: Preoperative D-dimer was significantly associated with postoperative AKI following non-cardiac surgery. The optimal cut-off point for preoperative D-dimer was 0.165 µg/mL by ROC approach and 0.38 µg/mL by minimum P-value approach.

scholarly journals The Effects of Administration of Exogenous Albumin Early after Non-cardiac Surgery on Postoperative AKI in Patients with Preoperative Hypoalbuminemia: A Prospective Propensity-score Matching Analysis

2021 ◽  
Author(s):  
Miao Yan ◽  
Wei-Jie Zhou ◽  
Min Xie ◽  
Sai-Nan Zhu ◽  
Nan Li ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Final Analysis ◽  
Surgical Intensive Care Unit ◽  
Control Group ◽  
Surgical Intensive Care ◽  
Postoperative Aki

Abstract BackgroundEvidence have shown that preoperative hypoalbuminemia is independently associated with acute kidney injury (AKI) after non-cardiac surgery. However, little study has investigated the effects of administration of exogenous albumin early after non-cardiac surgery on postoperative AKI in patients with preoperative hypoalbuminemia.MethodsThis study was a secondary analysis of the database of a previously conducted prospective cohort study. Data of 661 adult patients who underwent non-cardiac surgery and were admitted to Surgical Intensive Care Unit (SICU) after surgery from May 1, 2019 to November 30, 2020 were collected. 267 patients with preoperative hypoalbuminemia were screened, and divided into two groups according to whether they were administrated with exogenous albumin on the day of SICU admission. The demographic and perioperative data of the two groups were propensity-matched. ResultsAfter propensity score matching, 64 pairs of patients were included in the final analysis. The patients of albumin group showed relatively higher serum albumin level on postoperative day 1 than that in patients of control group (31.3±3.4 vs. 29.7±3.8, P=0.008), however, no difference was observed in postoperative AKI incidence in patients of the two groups (59.4% vs. 62.5%, P=0.717). Furthermore, there was no difference in other prognostic factors, such as the use of mechanical ventilation, occurrence of other postoperative complications, in-hospital mortality, length of SICU stay and postoperative hospital stay.ConclusionsFor patients with preoperative hypoalbuminemia following non-cardiac surgery, administration of exogenous albumin early after surgery had no beneficial effect on the incidence of postoperative AKI and other clinical outcomes.

scholarly journals Aqp2 may affect the occurrence of acute kidney injury after cardiopulmonary bypass

2020 ◽  
Author(s):  
Yingjie Xiao ◽  
Yanli Li ◽  
Wenpeng Dong ◽  
Long Gui ◽  
Xu Yu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Postoperative Complications ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Upward Trend ◽  
Before And After ◽  
Postoperative Aki

Abstract BACKGROUND Acute kidney injury (AKI) is one of the most important postoperative complications of cardiac surgery, and despite complete recovery of renal function after surgery, AKI is independently associated with high mortality within 10 years after surgery. Experiments show that Aquaporin 2(AQP2) is associated with postoperative AKI. Results of AQP2 release patterns after acute kidney injury have not been the same in different studies. METHODS We selected all patients undergoing extracorporeal circulation surgery, collected their urine samples before and after surgery, centrifuged at 3000 rpm for ten minutes, and detected the expression of AQP2 in urine by ELISA. RESULTS Most of the patients without AKI showed an upward trend of AQP2, while the patients with AKI showed a downward trend of AQP2. Patients with lower AQP2 levels before surgery have a lower chance of developing AKI. CONCLUSION AQP2 can be used to predict and prevent postoperative AKI.

scholarly journals Platelet Counts, Acute Kidney Injury, and Mortality after Coronary Artery Bypass Grafting Surgery

2016 ◽  
Vol 124 (2) ◽  
pp. 339-352 ◽  
Author(s):  
Miklos D. Kertai ◽  
Shan Zhou ◽  
Jörn A. Karhausen ◽  
Mary Cooter ◽  
Edmund Jooste ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Odds Ratio ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Bypass Grafting ◽  
Cabg Surgery ◽  
Platelet Counts ◽  
Postoperative Aki

Abstract Background Cardiac surgery requiring cardiopulmonary bypass is associated with platelet activation. Because platelets are increasingly recognized as important effectors of ischemia and end-organ inflammatory injury, the authors explored whether postoperative nadir platelet counts are associated with acute kidney injury (AKI) and mortality after coronary artery bypass grafting (CABG) surgery. Methods The authors evaluated 4,217 adult patients who underwent CABG surgery. Postoperative nadir platelet counts were defined as the lowest in-hospital values and were used as a continuous predictor of postoperative AKI and mortality. Nadir values in the lowest 10th percentile were also used as a categorical predictor. Multivariable logistic regression and Cox proportional hazard models examined the association between postoperative platelet counts, postoperative AKI, and mortality. Results The median postoperative nadir platelet count was 121 × 109/l. The incidence of postoperative AKI was 54%, including 9.5% (215 patients) and 3.4% (76 patients) who experienced stages II and III AKI, respectively. For every 30 × 109/l decrease in platelet counts, the risk for postoperative AKI increased by 14% (adjusted odds ratio, 1.14; 95% CI, 1.09 to 1.20; P &lt; 0.0001). Patients with platelet counts in the lowest 10th percentile were three times more likely to progress to a higher severity of postoperative AKI (adjusted proportional odds ratio, 3.04; 95% CI, 2.26 to 4.07; P &lt; 0.0001) and had associated increased risk for mortality immediately after surgery (adjusted hazard ratio, 5.46; 95% CI, 3.79 to 7.89; P &lt; 0.0001). Conclusion The authors found a significant association between postoperative nadir platelet counts and AKI and short-term mortality after CABG surgery.

scholarly journals Impact of Cardiac Function Improvement on Cardiac Surgery Associated Acute Kidney Injury for Patients with Preoperative Renal Dysfunction

2020 ◽  
Author(s):  
Jiarui Xu ◽  
Xin Chen ◽  
Jing Lin ◽  
Yang Li ◽  
Bo Shen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Cardiac Surgery ◽  
Cardiac Function ◽  
Renal Dysfunction ◽  
Significant Risk ◽  
Kidney Injury ◽  
Normal Function ◽  
Function Group ◽  
Postoperative Aki

Abstract Background: We aim to investigate whether the postoperative cardiac function improve or not would affect the risk of cardiac surgery associated acute kidney injury (AKI) for patients with preoperative renal dysfunction. Method: Data from patients underwent cardiac surgery from April 2012 to February 2016 were collected. Renal dysfunction was defined as preoperative SCr >1.2 mg/dL (females) or >1.5 mg/dL (males). Patients were grouped as normal renal function group, renal dysfunction with chronic kidney disease (CKD group), and non CKD group. △LVEF=postoperative LVEF - preoperative LVEF. Cardiac function improved was defined as △LVEF ≥10. Patients were further divided into non CKD & cardiac function improved (non CKD+), non CKD & cardiac function not improved (non CKD-), CKD & cardiac function improved (CKD+) and CKD & cardiac function not improved (CKD-) subgroups.Results: A total of 8,661 patients were allocated as normal renal function (n=7,903), non CKD(n = 662) and CKD (n = 136) groups. Both non CKD and CKD groups had higher AKI incidence than normal function group (39.5% vs 30.0%, P < 0.001; 61.8% vs 30.0%, P<0.001), and non CKD+ group had the similar AKI incidence with normal function group (30.9% vs 30.0%, P=0.729). Multivariate logistic regression analysis revealed that non CKD-, CKD+ and CKD- were significant risk factors, whereas non CKD+ was not a significant risk factor for postoperative AKI. The SCr at discharge in non CKD+ subgroup was significantly lower than its preoperative SCr (1.4 ± 0.8 vs 1.7 ± 0.9 mg/dL, P = 0.020).Conclusions: For renal dysfunction patients with no CKD, the risk of postoperative AKI did not exist if the cardiac function improved after surgery. For CKD patients, the risk of postoperative AKI increase regardless whether the cardiac function improved or not.

CIRP Secretion during Cardiopulmonary Bypass Is Associated with Increased Risk of Postoperative Acute Kidney Injury

2021 ◽  
Author(s):  
Wenyan Liu ◽  
Yang Yan ◽  
Dan Han ◽  
Yongxin Li ◽  
Qian Wang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Rna Binding ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Proinflammatory Response ◽  
Increased Risk ◽  
Before And After ◽  
The Difference

Abstract Background Systemic inflammation contributes to cardiac surgery–associated acute kidney injury (AKI). Cardiomyocytes and other organs experience hypothermia and hypoxia during cardiopulmonary bypass (CPB), which induces the secretion of cold-inducible RNA-binding protein (CIRP). Extracellular CIRP may induce a proinflammatory response. Materials and Methods The serum CIRP levels in 76 patients before and after cardiac surgery were determined to analyze the correlation between CIRP levels and CPB time. The risk factors for AKI after cardiac surgery and the in-hospital outcomes were also analyzed. Results The difference in the levels of CIRP (ΔCIRP) after and before surgery in patients who experienced cardioplegic arrest (CA) was 26-fold higher than those who did not, and 2.7-fold of those who experienced CPB without CA. The ΔCIRP levels were positively correlated with CPB time (r = 0.574, p < 0.001) and cross-clamp time (r = 0.54, p < 0.001). Multivariable analysis indicated that ΔCIRP (odds ratio: 1.003; 95% confidence interval: 1.000–1.006; p = 0.027) was an independent risk factor for postoperative AKI. Patients who underwent aortic dissection surgery had higher levels of CIRP and higher incidence of AKI than other patients. The incidence of AKI and duration of mechanical ventilation in patients whose serum CIRP levels more than 405 pg/mL were significantly higher than those less than 405 pg/mL (65.8 vs. 42.1%, p = 0.038; 23.1 ± 18.2 vs. 13.8 ± 9.2 hours, p = 0.007). Conclusion A large amount of CIRP was released during cardiac surgery. The secreted CIRP was associated with the increased risk of AKI after cardiac surgery.

scholarly journals Effects of Volatile versus Total Intravenous Anesthesia on Occurrence of Myocardial Injury after Non-Cardiac Surgery

2019 ◽  
Vol 8 (11) ◽  
pp. 1999 ◽  
Author(s):  
Kwon ◽  
Park ◽  
Lee ◽  
Oh ◽  
Lee ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Myocardial Injury ◽  
Kidney Injury ◽  
High Sensitivity ◽  
Total Intravenous Anesthesia ◽  
P Value ◽  
Type I ◽  
Intravenous Anesthesia ◽  
Remifentanil Infusion ◽  
New Onset

The cardioprotective effects of volatile anesthetics versus total intravenous anesthesia (TIVA) are controversial, especially in patients undergoing non-cardiac surgery. Using current generation high-sensitivity cardiac troponin (hs-cTn), we aimed to evaluate the effect of anesthetics on the occurrence of myocardial injury after non-cardiac surgery (MINS). From February 2010 to December 2016, 3555 patients without preoperative hs-cTn elevation underwent non-cardiac surgery under general anesthesia. Patients were grouped according to anesthetic agent; 659 patients were classified into a propofol-remifentanil total intravenous anesthesia (TIVA) group, and 2896 patients were classified into a volatile group. To balance the use of remifentanil between groups, a balanced group (n = 1622) was generated with patients who received remifentanil infusion in the volatile group, and two separate comparisons were performed (TIVA vs. volatile and TIVA vs. balanced). The primary outcome was occurrence of MINS, defined as rise of hs-cTn I ≥ 0.04 ng/mL within postoperative 48 hours. The secondary outcomes were 30-day mortality, postoperative acute kidney injury (AKI), and adverse events during hospital stay (mortality, type I myocardial infarction (MI), and new-onset arrhythmia). In propensity-matched analyses, the occurrence of MINS was lower in the TIVA group compared to the volatile group (OR 0.642; 95% CI 0.450–0.914; p = 0.014). However, after balancing the use of remifentanil, there was no difference between groups in the risk of MINS (OR 0.832; 95% CI 0.554–1.251; p-value = 0.377). There were no significant associations between the two groups in type 1 MI, new-onset atrial fibrillation, in-hospital and 30-day mortality before and after balancing the use of remifentanil. However, the incidence of postoperative AKI was lower in the TIVA group (OR 0.362; 95% CI 0.194–0.675; p-value = 0.001). After balancing the use of remifentanil, volatile anesthesia and TIVA showed comparable effects on MINS in patients undergoing non-cardiac surgery without preoperative myocardial injury. Further studies are needed on the benefit of remifentanil infusion.

scholarly journals Effect of liver resection-induced increases in hepatic venous pressure gradient on development of postoperative acute kidney injury

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Christian Reiterer ◽  
Alexander Taschner ◽  
Florian Luf ◽  
Manfred Hecking ◽  
Dietmar Tamandl ◽  
...  
Keyword(s):  
Liver Resection ◽  
Venous Pressure ◽  
Portal Pressure ◽  
Kidney Injury ◽  
Renin Angiotensin System ◽  
Plasma Renin ◽  
Secondary Outcome ◽  
Before And After ◽  
The Impact ◽  
Postoperative Aki

Abstract Background The impact of changes in portal pressure before and after liver resection (defined as ΔHVPG) on postoperative kidney function remains unknown. Therefore, we investigated the effect of ΔHVPG on (i) the incidence of postoperative AKI and (ii) the renin-angiotensin system (RAAS) and sympathetic nervous system (SNS) activity. Methods We included 30 patients undergoing partial liver resection. Our primary outcome was postoperative AKI according to KDIGO criteria. For our secondary outcome we assessed the plasma renin, aldosterone, noradrenaline, adrenaline, dopamine and vasopressin concentrations prior and 2 h after induction of anaesthesia, on the first and fifth postoperative day. HVPG was measured prior and immediately after liver resection. Results ΔHVPG could be measured in 21 patients with 12 patients HVPG showing increases in HVPG (∆HVPG≥1 mmHg) while 9 patients remained stable. AKI developed in 7/12 of patients with increasing HVPG, but only in 2/9 of patients with stable ΔHVPG (p = 0.302). Noradrenalin levels were significantly higher in patients with increasing ΔHVPG than in patients with stable ΔHVPG. (p = 0.009). Biomarkers reflecting RAAS and SNS activity remained similar in patients with increasing vs. stable ΔHVPG. Conclusions Patients with increased HVPG had higher postoperative creatinine concentrations, however, the incidence of AKI was similar between patients with increased versus stable HVPG.

scholarly journals Postoperative diastolic perfusion pressure is associated with the development of acute kidney injury in patients after cardiac surgery: A retrospective analysis

2019 ◽  
Author(s):  
Jifu Jin ◽  
Jiawei Yu ◽  
Su Chi Chang ◽  
Jiarui Xu ◽  
Sujuan Xu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Mean Arterial Pressure ◽  
Central Venous Pressure ◽  
Odds Ratio ◽  
Perfusion Pressure ◽  
Venous Pressure ◽  
Kidney Injury ◽  
Hemodynamic Parameters ◽  
Central Venous

Abstract Background We aimed to investigate the relationship between the perioperative hemodynamic parameters and the occurrence of cardiac surgery-associated acute kidney injury. Methods A retrospective study was performed in patients underwent cardiac surgery at a tertiary referral teaching hospital. Acute kidney injury was determined according to the KDIGO criteria. We investigated the association between the following perioperative hemodynamic parameters and cardiac surgery-associated acute kidney injury: mean arterial pressure, mean perfusion pressure, central venous pressure, and diastolic perfusion pressure. Multivariate regression analysis was conducted to identify the independent hemodynamic predictors for the development of acute kidney injury. Subgroup analysis was further performed in patients with chronic hypertension. Results Among 300 patients, 29.3% developed acute kidney injury during postoperative intensive care unit period. Multivariate logistic analysis showed the postoperative nadir diastolic perfusion pressure, but not mean arterial pressure, central venous pressure and mean perfusion pressure, was independently linked to the development of acute kidney injury after cardiac surgery (odds ratio 0.945, P = 0.045). Subgroup analyses in hypertensive subjects showed the postoperative nadir diastolic perfusion pressure and peak central venous pressure were both independently related to the development of acute kidney injury (nadir diastolic perfusion pressure, odds ratio 0.886, P = 0.033; peak central venous pressure, odds ratio 1.328, P = 0.010, respectively). Conclusions Postoperative nadir diastolic perfusion pressure was independently associated with the development of cardiac surgery-associated acute kidney injury. Furthermore, central venous pressure should be considered as a potential hemodynamic target for hypertensive patients undergoing cardiac surgery.

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