Sehoon Park1,2, Hyung-Chul Lee3, Chul-Woo Jung3, Yunhee Choi4, Hyung Jin Yoon5, Sejoong Kim6,7, Ho Jun Chin6,7, Myoungsuk Kim8, Yong Chul Kim9, Dong Ki Kim7,9,10, Kwon Wook Joo7,9,10, Yon Su Kim1,7,9,10, Hajeong Lee11. 1. Departments of Biomedical Sciences. 2. Department of Internal Medicine, Armed Forces Capital Hospital, Gyeonggi-do, Korea. 3. Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea. 4. Medical Research Collaborating Center. 5. Biomedical Engineering, and. 6. Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea. 7. Internal Medicine, and. 8. Biomedical Research Institute, and. 9. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; and. 10. Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea. 11. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; and mdhjlee@gmail.com.
Abstract
BACKGROUND AND OBJECTIVES: High BP variability may cause AKI because of inappropriate kidney perfusion. This study aimed to investigate the association between intraoperative BP variability and postoperative AKI in patients who underwent noncardiac surgery. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a cohort study of adults undergoing noncardiac surgery in hospitals in South Korea. We studied three cohorts using the following recording windows for intraoperative BP: discovery cohort, 1-minute intervals; first validation cohort, 5-minute intervals; and second validation cohort, 2-second intervals. We calculated four variability parameters (SD, coefficient of variation, variation independent of mean, and average real variability) based on the measured mean arterial pressure values. The primary outcomes were postoperative AKI (defined by the Kidney Disease Improving Global Outcomes serum creatinine cutoffs) and critical AKI (consisting of stage 2 or higher AKI and post-AKI death or dialysis within 90 days). RESULTS: In the three cohorts, 45,520, 29,704, and 7435 patients were analyzed, each with 2230 (443 critical), 1552 (444 critical), and 300 (91 critical) postoperative AKI events, respectively. In the discovery cohort, all variability parameters were significantly associated with risk of AKI, even after adjusting for intraoperative hypotension. For example, average real variability was associated with higher risks of postoperative AKI (adjusted odds ratio, 1.13 per 1 SD increment; 95% CI, 1.07 to 1.19) and critical AKI (adjusted odds ratio, 1.13 per 1 SD increment; 95% CI, 1.02 to 1.26). Associations were evident predominantly among patients who also experienced intraoperative hypotension. In the validation analysis with 5-minute-interval BP records, all four variability parameters were associated with the risk of postoperative AKI or critical AKI. In the validation cohort with 2-second-interval BP records, average real variability was the only significant variability parameter. CONCLUSIONS: Higher intraoperative BP variability is associated with higher risks of postoperative AKI after noncardiac surgery, independent of hypotension and other clinical characteristics.
BACKGROUND AND OBJECTIVES: High BP variability may cause AKI because of inappropriate kidney perfusion. This study aimed to investigate the association between intraoperative BP variability and postoperative AKI in patients who underwent noncardiac surgery. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a cohort study of adults undergoing noncardiac surgery in hospitals in South Korea. We studied three cohorts using the following recording windows for intraoperative BP: discovery cohort, 1-minute intervals; first validation cohort, 5-minute intervals; and second validation cohort, 2-second intervals. We calculated four variability parameters (SD, coefficient of variation, variation independent of mean, and average real variability) based on the measured mean arterial pressure values. The primary outcomes were postoperative AKI (defined by the Kidney Disease Improving Global Outcomes serum creatinine cutoffs) and critical AKI (consisting of stage 2 or higher AKI and post-AKI death or dialysis within 90 days). RESULTS: In the three cohorts, 45,520, 29,704, and 7435 patients were analyzed, each with 2230 (443 critical), 1552 (444 critical), and 300 (91 critical) postoperative AKI events, respectively. In the discovery cohort, all variability parameters were significantly associated with risk of AKI, even after adjusting for intraoperative hypotension. For example, average real variability was associated with higher risks of postoperative AKI (adjusted odds ratio, 1.13 per 1 SD increment; 95% CI, 1.07 to 1.19) and critical AKI (adjusted odds ratio, 1.13 per 1 SD increment; 95% CI, 1.02 to 1.26). Associations were evident predominantly among patients who also experienced intraoperative hypotension. In the validation analysis with 5-minute-interval BP records, all four variability parameters were associated with the risk of postoperative AKI or critical AKI. In the validation cohort with 2-second-interval BP records, average real variability was the only significant variability parameter. CONCLUSIONS: Higher intraoperative BP variability is associated with higher risks of postoperative AKI after noncardiac surgery, independent of hypotension and other clinical characteristics.
Authors: O Collange; L Jazaerli; A Lejay; C Biermann; S Caillard; B Moulin; N Chakfe; F Severac; M Schaeffer; P-M Mertes; A Steib Journal: Transplant Proc Date: 2016-10 Impact factor: 1.066
Authors: Sehoon Park; Hyunjeong Cho; Seokwoo Park; Soojin Lee; Kwangsoo Kim; Hyung Jin Yoon; Jiwon Park; Yunhee Choi; Suehyun Lee; Ju Han Kim; Sejoong Kim; Ho Jun Chin; Dong Ki Kim; Kwon Wook Joo; Yon Su Kim; Hajeong Lee Journal: J Am Soc Nephrol Date: 2018-12-18 Impact factor: 10.121
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Authors: Amit X Garg; P J Devereaux; Salim Yusuf; Meaghan S Cuerden; Chirag R Parikh; Steven G Coca; Michael Walsh; Richard Novick; Richard J Cook; Anil R Jain; Xiangbin Pan; Nicolas Noiseux; Karel Vik; Noedir A Stolf; Andrew Ritchie; Roberto R Favaloro; Sirish Parvathaneni; Richard P Whitlock; Yongning Ou; Mitzi Lawrence; Andre Lamy Journal: JAMA Date: 2014-06-04 Impact factor: 56.272