Narut Prasitlumkum1, Wisit Cheungpasitporn2, Ryota Sato3, Ronpichai Chokesuwattanaskul4, Charat Thongprayoon2, Sri Harsha Patlolla5, Tarun Bathini6, Michael A Mao7, S Tanveer Rab8, Kianoush Kashani2,9, Saraschandra Vallabhajosyula8. 1. Division of Cardiology, University of California Riverside, Riverside, California. 2. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota. 3. Critical Care Unit, Cleveland Clinic, Cleveland, Ohio. 4. Department of Cardiology, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand. 5. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota. 6. Department of Internal Medicine, University of Arizona, Tucson, Arizona. 7. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, Florida. 8. Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. 9. Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Abstract
OBJECTIVE: Acute kidney injury (AKI) is associated with higher morbidity and mortality in cardiac arrest (CA). There are limited contemporary data on the incidence and outcomes of AKI in CA. METHODS: We comprehensively searched the databases of MEDLINE, EMBASE, PUBMED, and the Cochrane from inception to November 2020. Observational studies that reported the incidence of AKI in CA survivors were included. Data from each study were combined using the random effects to calculate pooled incidence and risk ratios with 95% confidence intervals (CIs). The primary outcome was short-term mortality and secondary outcomes included long-term mortality, incidence of AKI and use of renal replacement therapy (RRT). Subgroup and meta-regression analyses were performed to explore heterogeneity. MAIN RESULTS: A total of 25 observational studies comprising 8,165 patients were included. The incidence of AKI in CA survivors was 40.3%, (range 32.9-47.8%). In stage 3 AKI, 1/4th of patients required RRT. AKI was associated with an increased risk of both short-term (OR 2.27 [95% CI 1.74-2.96]; p<0.001) and long-term mortality (OR 1.51 [95% CI 1.93-3.25]; p<0.001). Meta-regression and subgroup analyses did not suggest any effect of hypothermia on incidence of AKI. CONCLUSION: AKI complicates the care of 40% of CA survivors and is associated with significantly increased short and long-term mortality.
OBJECTIVE:Acute kidney injury (AKI) is associated with higher morbidity and mortality in cardiac arrest (CA). There are limited contemporary data on the incidence and outcomes of AKI in CA. METHODS: We comprehensively searched the databases of MEDLINE, EMBASE, PUBMED, and the Cochrane from inception to November 2020. Observational studies that reported the incidence of AKI in CA survivors were included. Data from each study were combined using the random effects to calculate pooled incidence and risk ratios with 95% confidence intervals (CIs). The primary outcome was short-term mortality and secondary outcomes included long-term mortality, incidence of AKI and use of renal replacement therapy (RRT). Subgroup and meta-regression analyses were performed to explore heterogeneity. MAIN RESULTS: A total of 25 observational studies comprising 8,165 patients were included. The incidence of AKI in CA survivors was 40.3%, (range 32.9-47.8%). In stage 3 AKI, 1/4th of patients required RRT. AKI was associated with an increased risk of both short-term (OR 2.27 [95% CI 1.74-2.96]; p<0.001) and long-term mortality (OR 1.51 [95% CI 1.93-3.25]; p<0.001). Meta-regression and subgroup analyses did not suggest any effect of hypothermia on incidence of AKI. CONCLUSION: AKI complicates the care of 40% of CA survivors and is associated with significantly increased short and long-term mortality.