Hjalmar R Bouma1, Hubert E Mungroop2, A Fred de Geus2, Daniel D Huisman2, Maarten W N Nijsten3, Massimo A Mariani4, Thomas W L Scheeren2, Johannes G M Burgerhof5, Robert H Henning6, Anne H Epema2. 1. Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands; Department of Internal Medicine, University Medical Center Groningen, University of Groningen, The Netherlands. Electronic address: h.r.bouma@umcg.nl. 2. Department of Anesthesiology, University Medical Center Groningen, University of Groningen, The Netherlands. 3. Department of Critical Care Medicine, University Medical Center Groningen, University of Groningen, The Netherlands. 4. Department of Cardio-Thoracic Surgery, University Medical Center Groningen, University of Groningen, The Netherlands. 5. Department of Epidemiology, University Medical Center Groningen, University of Groningen, The Netherlands. 6. Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands.
Abstract
BACKGROUND: Perioperative acute kidney injury (AKI) is an important predictor of long-term all-cause mortality after coronary artery bypass (CABG). However, the effect of AKI on long-term mortality after cardiac valve operations is hitherto undocumented. METHODS: Perioperative renal injury and long-term all-cause mortality after valve operations were studied in a prospective cohort of patients undergoing solitary valve operations (n = 2,806) or valve operations combined with CABG (n = 1,260) with up to 18 years of follow-up. Postoperative serum creatinine increase was classified according to AKI staging 0 to 3. Patients undergoing solitary CABG (n = 4,938) with cardiopulmonary bypass served as reference. RESULTS: In both valve and valve+CABG operations, postoperative renal injury of AKI stage 1 or higher was progressively associated with an increase in long-term mortality (hazard ratio [HR], 2.27, p < 0.05 for valve; HR, 1.65, p < 0.05 for valve+CABG; HR, 1.56, p < 0.05 for CABG). Notably, the mortality risk increased already substantially at serum creatinine increases of 10% to 25%-that is, far below the threshold for AKI stage 1 after valve operations (HR, 1.39, p < 0.05), but not after valve operations combined with CABG or CABG only. CONCLUSIONS: An increase in serum creatinine by more than 10% during the first week after valve operation is associated with an increased risk for long-term mortality after cardiac valve operation. Thus, AKI classification clearly underestimates long-term mortality risk in patients undergoing valve operations.
BACKGROUND: Perioperative acute kidney injury (AKI) is an important predictor of long-term all-cause mortality after coronary artery bypass (CABG). However, the effect of AKI on long-term mortality after cardiac valve operations is hitherto undocumented. METHODS: Perioperative renal injury and long-term all-cause mortality after valve operations were studied in a prospective cohort of patients undergoing solitary valve operations (n = 2,806) or valve operations combined with CABG (n = 1,260) with up to 18 years of follow-up. Postoperative serum creatinine increase was classified according to AKI staging 0 to 3. Patients undergoing solitary CABG (n = 4,938) with cardiopulmonary bypass served as reference. RESULTS: In both valve and valve+CABG operations, postoperative renal injury of AKI stage 1 or higher was progressively associated with an increase in long-term mortality (hazard ratio [HR], 2.27, p < 0.05 for valve; HR, 1.65, p < 0.05 for valve+CABG; HR, 1.56, p < 0.05 for CABG). Notably, the mortality risk increased already substantially at serum creatinine increases of 10% to 25%-that is, far below the threshold for AKI stage 1 after valve operations (HR, 1.39, p < 0.05), but not after valve operations combined with CABG or CABG only. CONCLUSIONS: An increase in serum creatinine by more than 10% during the first week after valve operation is associated with an increased risk for long-term mortality after cardiac valve operation. Thus, AKI classification clearly underestimates long-term mortality risk in patients undergoing valve operations.
Authors: Ferdinand Vogt; Janez Zibert; Alenka Bahovec; Francesco Pollari; Joachim Sirch; Matthias Fittkau; Thomas Bertsch; Martin Czerny; Giuseppe Santarpino; Theodor Fischlein; Jurij M Kalisnik Journal: Interact Cardiovasc Thorac Surg Date: 2021-06-28
Authors: José Castela Forte; Hubert E Mungroop; Fred de Geus; Maureen L van der Grinten; Hjalmar R Bouma; Ville Pettilä; Thomas W L Scheeren; Maarten W N Nijsten; Massimo A Mariani; Iwan C C van der Horst; Robert H Henning; Marco A Wiering; Anne H Epema Journal: Sci Rep Date: 2021-02-10 Impact factor: 4.379
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Authors: K D W Hendriks; J N Castela Forte; W F Kok; H E Mungroop; H R Bouma; T W L Scheeren; M Mariani; R H Henning; A H Epema Journal: PLoS One Date: 2022-08-25 Impact factor: 3.752