M Scherner1,2, C Weber3, H Schmidt4,5, K Kuhr5, S Hamacher5, A Sabashnikov3, K Eghbalzadeh3, N Mader3, T Wahlers3, J Wippermann6. 1. Dept. of Cardiothoracic Surgery, University of Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany. maximilian.scherner@med.ovgu.de. 2. Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany. maximilian.scherner@med.ovgu.de. 3. Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany. 4. Departement of Cardiology, Klinikum Magdeburg, Magdeburg, Germany. 5. Faculty of Medicine, University of Halle, Halle, Germany. 6. Dept. of Cardiothoracic Surgery, University of Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany.
Abstract
OBJECTIVES: There is limited knowledge regarding the specific interrelationships between urgent coronary artery bypass graft (U-CABG) surgery and postoperative acute kidney injury (AKI). We aimed to (1) analyze the impact of urgent CABG (U-CABG) on the incidence and severity of postoperative AKI, (2) estimate the influence of AKI after U‑CABG or elective CABG (E-CABG) on mortality and (3) identify risk factors for AKI depending on the urgency of operation. RESULTS: U‑CABG patients showed a higher incidence of AKI (49.8% vs. E‑CABG: 39.7%; p = 0.026), especially for higher AKI stages 2 + 3. In-hospital mortality was higher in U‑CABG patients (12.6%) compared to E‑CABG patients (2.3%; p < 0.001). The impact of AKI on mortality did not differ, but showed a strong coherency between higher AKI stages (2 + 3) and mortality (stage 1: OR 2.409, 95% CI 1.017-5.706; p = 0.046 vs. stage 2 + 3: OR 5.577; 95% CI 2.033-15.3; p = 0.001). Univariate logistic regression analysis revealed that preoperative renal impairment, peripheral vascular disease and transfusion of more than two red blood cell concentrates were predictors for postoperative AKI in both groups. CONCLUSIONS: U‑CABG is a risk factor for postoperative AKI and even "mild" AKI leads to a significantly higher mortality. Hence, the prevention of modifiable risk factors might reduce the incidence of postoperative AKI and thus improve outcome.
OBJECTIVES: There is limited knowledge regarding the specific interrelationships between urgent coronary artery bypass graft (U-CABG) surgery and postoperative acute kidney injury (AKI). We aimed to (1) analyze the impact of urgent CABG (U-CABG) on the incidence and severity of postoperative AKI, (2) estimate the influence of AKI after U‑CABG or elective CABG (E-CABG) on mortality and (3) identify risk factors for AKI depending on the urgency of operation. RESULTS: U‑CABG patients showed a higher incidence of AKI (49.8% vs. E‑CABG: 39.7%; p = 0.026), especially for higher AKI stages 2 + 3. In-hospital mortality was higher in U‑CABG patients (12.6%) compared to E‑CABG patients (2.3%; p < 0.001). The impact of AKI on mortality did not differ, but showed a strong coherency between higher AKI stages (2 + 3) and mortality (stage 1: OR 2.409, 95% CI 1.017-5.706; p = 0.046 vs. stage 2 + 3: OR 5.577; 95% CI 2.033-15.3; p = 0.001). Univariate logistic regression analysis revealed that preoperative renal impairment, peripheral vascular disease and transfusion of more than two red blood cell concentrates were predictors for postoperative AKI in both groups. CONCLUSIONS: U‑CABG is a risk factor for postoperative AKI and even "mild" AKI leads to a significantly higher mortality. Hence, the prevention of modifiable risk factors might reduce the incidence of postoperative AKI and thus improve outcome.
Authors: G Landoni; T Bove; M Crivellari; D Poli; O Fochi; C Marchetti; A Romano; G Marino; A Zangrillo Journal: Minerva Anestesiol Date: 2007-11 Impact factor: 3.051
Authors: Jeremiah R Brown; Richard P Cochran; Bruce J Leavitt; Lawrence J Dacey; Cathy S Ross; Todd A MacKenzie; Karyn S Kunzelman; Robert S Kramer; Felix Hernandez; Robert E Helm; Benjamin M Westbrook; Robert F Dunton; David J Malenka; Gerald T O'Connor Journal: Circulation Date: 2007-09-11 Impact factor: 29.690