Abstract
BackgroundPostoperative acute kidney injury (AKI) is common following cardiac surgery (CS). Body weight (BW) may be an amenable variable by representing the summation of the nutritional and the fluid status. However, the predictive role of perioperative BW changes in CS patients with severe postoperative AKI is never explored. This study aimed to evaluate this association.MethodsThis study was conducted using a prospectively collected multicenter cohort, NSARF (National Taiwan University Hospital Study Group on Acute Renal Failure) database. The adult CS patients with postoperative AKI requiring renal replacement therapy (RRT), who had clear initial consciousness, received CS within 14 days of hospitalization, and underwent RRT within seven days after CS in intensive care units from January 2001 to January 2014 were enrolled. With the endpoint of 30-day postoperative mortality, we evaluated the association between the clinical factors denoting fluid status and patients outcomes.ResultsA total of 188 patients (70 female, mean age 63.7 ± 15.2 years) were enrolled. Comparing with the survivors (n = 124), the non-survivors (n = 64) had a significantly higher perioperative BW change [3.6 ± 6.1% versus 0.1 ± 8.3%, p = 0.003] but not the postoperative and pre-RRT BW changes. By using multivariate Cox proportional hazards model, the independent indicators of 30-day postoperative mortality included perioperative BW change (p = 0.026) and packed red blood cells transfusion (p = 0.007), postoperative intra-aortic balloon pump (p = 0.001) and central venous pressure level (p = 0.005), as well as heart rate (p = 0.022), sequential organ failure assessment score (p < 0.001), logistic organ dysfunction score (p = 0.001), and blood total bilirubin level (p = 0.044) at RRT initiation. The generalized additive models further demonstrated, in a multivariate manner, that the mortality risk rose significantly during a perioperative BW change of 2% to 15%.ConclusionsPerioperative BW change was independently associated with an increased risk for 30-day postoperative mortality in CS patients with RRT-requiring AKI.
Highlights
Acute kidney injury (AKI) is a common yet potentially serious complication after cardiac surgery (CS)
Perioperative Body weight (BW) change was independently associated with an increased risk for 30-day postoperative mortality in CS patients with renal replacement therapy (RRT)-requiring acute kidney injury (AKI)
The postoperative prognoses after CS are varied with many factors such as patient characteristics, preexisting comorbidities, inflammatory activity, and duration of extracorporeal circulation. [8, 9] Besides, body weight (BW) or BW change is an important but often overlooked indicator for patient outcomes in many clinical settings. [9, 10] It is accepted that an unintended BW loss of > 10% within six months is indicative of undernutrition and is associated with adverse patient outcomes
Summary
Acute kidney injury (AKI) is a common yet potentially serious complication after cardiac surgery (CS). [4] The pathophysiology of postoperative AKI in CS patients is complex and multifactorial, which includes several factors such as exogenous and endogenous toxins, metabolic factors, ischemia-reperfusion injury, neurohormonal activation, embolization, hemodynamic alterations, along with inflammation and oxidative stress. These mechanisms likely interact with each other at different time points during the period from preoperative stage to postoperative stages of the CS. The patient during the perioperative stage is in a stressful situation with highly dynamic and catabolic status which on the one hand would precipitate BW loss via the Perioperative body weight change and in-hospital mortality in acute kidney injury depletion of glycogen and subcutaneous fat, as well as the wasting of the muscle.
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