CARDIAC SURGERY ASSOCIATED KIDNEY INJURY: PREDICTORS, BIOMARKERS AND PREVENTION ASSOCIATED COST REDUCTION

Abstract

Objective To determine the incidence and main predictors of cardiac surgery associated acute kidney injury (CS-AKI), as well as to evaluate hospital and intensive care unit length of stay (LOS) in these patients. A secondary exploratory analysis was made to estimate the potential benefit of including damage biomarkers evaluation in our clinical practice. Design and Method A consecutive sample of adults who underwent elective cardiac surgery between January and March 2015 were included in an University Hospital single-centre retrospective cohort study. Results A total of 274 patients were admitted during the study period. CS-AKI occurred in 86. After adjustment, higher preoperative serum creatinine (mg/L, ORadj =1.10; CI95%: 1.01-1.19), lower preoperative hemoglobin (g/dL, ORadj =0.80; CI95%: 0.70-0.98), preoperative hypertension (ORadj=2.91; CI95%: 1.24-6.84), an increase in cardiopulmonary bypass (CPB) time (min, ORadj=1.01; CI95%:1.00-1.01) and perioperative use of sodium nitroprusside (ORadj=5.31; CI95%:1.51-18.72) remained significantly associated with CS-AKI. The expected cumulative surplus cost for the hospital, associated with CS-AKI (86 patients), was 120,695.84 EUR. Based on a median ARR of 16.6% we would expect a break-event point upon screening 78 patients, which would translate in our 276 patients’ cohort in an overall cost benefit of 7.145 EUR. Conclusions Preoperative hemoglobin, serum creatinine, systemic hypertension, CPB time and perioperative nitroprusside were settled as CS-AKI independent predictors. The use of damage biomarkers combined with early treatment strategy could be associated with a potential cost savings. To determine the incidence and main predictors of cardiac surgery associated acute kidney injury (CS-AKI), as well as to evaluate hospital and intensive care unit length of stay (LOS) in these patients. A secondary exploratory analysis was made to estimate the potential benefit of including damage biomarkers evaluation in our clinical practice. A consecutive sample of adults who underwent elective cardiac surgery between January and March 2015 were included in an University Hospital single-centre retrospective cohort study. A total of 274 patients were admitted during the study period. CS-AKI occurred in 86. After adjustment, higher preoperative serum creatinine (mg/L, ORadj =1.10; CI95%: 1.01-1.19), lower preoperative hemoglobin (g/dL, ORadj =0.80; CI95%: 0.70-0.98), preoperative hypertension (ORadj=2.91; CI95%: 1.24-6.84), an increase in cardiopulmonary bypass (CPB) time (min, ORadj=1.01; CI95%:1.00-1.01) and perioperative use of sodium nitroprusside (ORadj=5.31; CI95%:1.51-18.72) remained significantly associated with CS-AKI. The expected cumulative surplus cost for the hospital, associated with CS-AKI (86 patients), was 120,695.84 EUR. Based on a median ARR of 16.6% we would expect a break-event point upon screening 78 patients, which would translate in our 276 patients’ cohort in an overall cost benefit of 7.145 EUR. Preoperative hemoglobin, serum creatinine, systemic hypertension, CPB time and perioperative nitroprusside were settled as CS-AKI independent predictors. The use of damage biomarkers combined with early treatment strategy could be associated with a potential cost savings.