Jeremiah R Brown1, Heather Thiessen-Philbrook2, Christine A Goodrich3, Andrew R Bohm3, Shama S Alam3, Steven G Coca4, Eric McArthur5, Amit X Garg5, Chirag R Parikh2. 1. The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Electronic address: jeremiah.r.brown@dartmouth.edu. 2. Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, Maryland. 3. The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire. 4. Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 5. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Acute kidney injury (AKI) is a common complication of cardiac surgery. Postprocedural AKI is a risk factor for 30-day readmission. We sought to examine the association of AKI and kidney injury biomarkers with readmission after cardiac surgery. METHODS: Patients alive at discharge who underwent cardiac surgery from the Translational Research Investigating Biomarker Endpoints-AKI cohort were enrolled from six medical centers in the United States and Canada. AKI duration was defined as the total number of days AKI was present during index admission (no AKI, 1-2, 3-6, and 7+ days). Preoperative and postoperative urinary levels were collected for interleukin-18, neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, liver-fatty-acid-binding protein, cystatin C, microalbumin, creatinine, and albumin-to-creatinine ratio. Readmission and death events were identified through US (Medicare) and Canadian administrative databases at 30 days and 365 days after discharge. RESULTS: Of 968 patients 15.9% were readmitted or died within 30 days of discharge and 35.9% were readmitted or died within 365 days. AKI duration of 3 to 6 days was significantly associated with 30-day readmission or death (adjusted odds ratio, 1.82%; 95% confidence interval, 1.08-3.05). Patients with AKI duration ≥ 7 days had increased odds of readmission or death at both 30 days (adjusted odds ratio, 2.49%; 95% confidence interval, 1.15-5.43) and 365 days (adjusted odds ratio, 3.67%; 95% confidence interval, 1.73-7.79). Urinary biomarkers had no association with readmission and death. CONCLUSIONS: AKI duration ≥ 3 days, and not kidney biomarkers, was strongly associated with readmission or death. These clinical outcomes are potentially due to cardiovascular or hemodynamic causes rather than intrinsic injury to the kidney parenchyma.
BACKGROUND:Acute kidney injury (AKI) is a common complication of cardiac surgery. Postprocedural AKI is a risk factor for 30-day readmission. We sought to examine the association of AKI and kidney injury biomarkers with readmission after cardiac surgery. METHODS:Patients alive at discharge who underwent cardiac surgery from the Translational Research Investigating Biomarker Endpoints-AKI cohort were enrolled from six medical centers in the United States and Canada. AKI duration was defined as the total number of days AKI was present during index admission (no AKI, 1-2, 3-6, and 7+ days). Preoperative and postoperative urinary levels were collected for interleukin-18, neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, liver-fatty-acid-binding protein, cystatin C, microalbumin, creatinine, and albumin-to-creatinine ratio. Readmission and death events were identified through US (Medicare) and Canadian administrative databases at 30 days and 365 days after discharge. RESULTS: Of 968 patients 15.9% were readmitted or died within 30 days of discharge and 35.9% were readmitted or died within 365 days. AKI duration of 3 to 6 days was significantly associated with 30-day readmission or death (adjusted odds ratio, 1.82%; 95% confidence interval, 1.08-3.05). Patients with AKI duration ≥ 7 days had increased odds of readmission or death at both 30 days (adjusted odds ratio, 2.49%; 95% confidence interval, 1.15-5.43) and 365 days (adjusted odds ratio, 3.67%; 95% confidence interval, 1.73-7.79). Urinary biomarkers had no association with readmission and death. CONCLUSIONS: AKI duration ≥ 3 days, and not kidney biomarkers, was strongly associated with readmission or death. These clinical outcomes are potentially due to cardiovascular or hemodynamic causes rather than intrinsic injury to the kidney parenchyma.
Authors: Jeremiah R Brown; Chirag R Parikh; Cathy S Ross; Robert S Kramer; Patrick C Magnus; Kristine Chaisson; Richard A Boss; Robert E Helm; Susan R Horton; Patricia Hofmaster; Helen Desaulniers; Pamela Blajda; Benjamin M Westbrook; Dennis Duquette; Kelly LeBlond; Reed D Quinn; Cheryl Jones; Anthony W DiScipio; David J Malenka Journal: Ann Thorac Surg Date: 2013-10-08 Impact factor: 4.330
Authors: C R Parikh; J Mishra; H Thiessen-Philbrook; B Dursun; Q Ma; C Kelly; C Dent; P Devarajan; C L Edelstein Journal: Kidney Int Date: 2006-05-17 Impact factor: 10.612
Authors: Chirag R Parikh; Heather Thiessen-Philbrook; Amit X Garg; Deepak Kadiyala; Michael G Shlipak; Jay L Koyner; Charles L Edelstein; Prasad Devarajan; Uptal D Patel; Michael Zappitelli; Catherine D Krawczeski; Cary S Passik; Steven G Coca Journal: Clin J Am Soc Nephrol Date: 2013-04-18 Impact factor: 8.237
Authors: Jeremiah R Brown; Jeffrey P Jacobs; Shama S Alam; Heather Thiessen-Philbrook; Allen Everett; Donald S Likosky; Kevin Lobdell; Moritz C Wyler von Ballmoos; Devin M Parker; Amit X Garg; Todd Mackenzie; Marshall L Jacobs; Chirag R Parikh Journal: Ann Thorac Surg Date: 2018-08-04 Impact factor: 4.330
Authors: Allen D Everett; Shama S Alam; Sherry L Owens; Devin M Parker; Christine Goodrich; Donald S Likosky; Heather Thiessen-Philbrook; Moritz Wyler von Ballmoos; Kevin Lobdell; Todd A MacKenzie; Jeffrey Jacobs; Chirag R Parikh; Anthony W DiScipio; David J Malenka; Jeremiah R Brown Journal: J Extra Corpor Technol Date: 2019-12