Alexandra Briggs1, Joaquim M Havens2, Ali Salim2, Kenneth B Christopher3. 1. Brigham and Women's Hospital, Division of Trauma, Burn, and Surgical Critical Care, Boston, Massachusetts, USA; The University of Pittsburgh Medical Center, Division of Trauma and General Surgery, Pittsburgh, PA, USA. Electronic address: briggsa@upmc.edu. 2. Brigham and Women's Hospital, Division of Trauma, Burn, and Surgical Critical Care, Boston, Massachusetts, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital Boston, Massachusetts, USA. 3. The Nathan E. Hellman Memorial Laboratory, Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Abstract
BACKGROUND: Patients undergoing Emergency General Surgery (EGS) have increased risk of complications and death. The risk of AKI in patients undergoing EGS, along with associated outcomes, is unknown. METHODS: This two-institution observational study included adults admitted to intensive care units between 1997 and 2012. EGS was defined by 7 procedures occurring within 48 hours of ICU admission. The main outcome studied was AKI within 5 days, along with 90-day mortality. RESULTS: In our cohort of 59,604 patients, 1758 (2.9%) underwent EGS. Risk of AKI in EGD patients was significantly increased relative to non-EGS patients, with adjusted odds of 1.7 (95%CI 1.40-1.94; P < 0.001). Risk of renal replacement for EGS patients was also increased, with odds of 1.8 (95%CI 1.37-2.46; P < 0.001). EGS patients were at significantly higher risk of 90-day mortality, with adjusted odds of 3.1 (95%CI 2.16-4.33,p < 0.001) for AKI and 4.5 (95%CI 2.58-7.96,p < 0.001) for AKI requiring renal replacement, relative to the absence of AKI. CONCLUSIONS: EGS is a robust risk factor for AKI in critically ill patients, the development of which is strongly predictive of increased 90-day mortality.
BACKGROUND:Patients undergoing Emergency General Surgery (EGS) have increased risk of complications and death. The risk of AKI in patients undergoing EGS, along with associated outcomes, is unknown. METHODS: This two-institution observational study included adults admitted to intensive care units between 1997 and 2012. EGS was defined by 7 procedures occurring within 48 hours of ICU admission. The main outcome studied was AKI within 5 days, along with 90-day mortality. RESULTS: In our cohort of 59,604 patients, 1758 (2.9%) underwent EGS. Risk of AKI in EGD patients was significantly increased relative to non-EGSpatients, with adjusted odds of 1.7 (95%CI 1.40-1.94; P < 0.001). Risk of renal replacement for EGSpatients was also increased, with odds of 1.8 (95%CI 1.37-2.46; P < 0.001). EGSpatients were at significantly higher risk of 90-day mortality, with adjusted odds of 3.1 (95%CI 2.16-4.33,p < 0.001) for AKI and 4.5 (95%CI 2.58-7.96,p < 0.001) for AKI requiring renal replacement, relative to the absence of AKI. CONCLUSIONS:EGS is a robust risk factor for AKI in critically ill patients, the development of which is strongly predictive of increased 90-day mortality.
Authors: Theis B Mikkelsen; Anders Schack; Jakob O Oreskov; Ismail Gögenur; Jakob Burcharth; Sarah Ekeloef Journal: BMC Nephrol Date: 2022-03-05 Impact factor: 2.388