Abstract
Acute kidney injury (AKI) after open cardiac surgery is associated with a longer hospital stay and higher risk of mortality. We aimed to explore the association between preoperative serum fibrinogen level and risk of postoperative AKI in patients with open cardiac surgery. 3459 patients who underwent cardiac valve replacement surgery from January 2011 to September 2015 were recruited. The primary outcome was AKI, defined as AKI stage-1 or higher based on the Kidney Disease: Improving Global Outcomes (KDIGO) Guidelines. Synthetic Minority Oversampling Technique (SMOTE) was used to subsample minority groups to eliminate classification bias. 510 (14.74%) patients developed postoperative AKI. Serum fibrinogen was independently associated with AKI (OR = 1.211, 95% CI 1.080 to 1.358, p = 0.001) after adjustment of covariates. The receiver operator characteristic (ROC) curve for the outcome of AKI, after the addition of serum fibrinogen, had a c-statistic increasing from 0.72 to 0.73 (p < 0.001). This translated to a substantially improved AKI risk classification with a net reclassification index of 0.178 (p < 0.001). After SMOTE subsampling, serum fibrinogen was still independently associated with AKI grade 1 or higher (OR = 1.212, 95% CI 1.1089 to 1.347, p = 0.003). Preoperative serum fibrinogen levels were associated with the risk of postoperative AKI after cardiac valve replacement surgery.
Highlights
Acute kidney injury (AKI) is an adverse postoperative complication of cardiac valve surgery and occurs in 3–30% of patients after surgery, which is independently associated with a longer hospital stay and higher risk of shortand long-term mortality[1,2]
The most significant differences were that patients with postoperative AKI were older, male, more likely to have hypertension, diabetes mellitus, cerebrovascular disease and obesity, more likely to have poor left ventricular ejection fraction (LVEF), lower estimated glomerular filtration and anemia, and more likely to undergo reoperations and a combined valve replacement surgery and others
Serum fibrinogen was higher in patients with postoperative AKI subsequent to cardiac valve replacement surgery (2.95 ± 0.91 vs. 2.72 ± 0.79; p = 0.002)
Summary
Acute kidney injury (AKI) is an adverse postoperative complication of cardiac valve surgery and occurs in 3–30% of patients after surgery, which is independently associated with a longer hospital stay and higher risk of shortand long-term mortality[1,2]. Cardiac valve replacement surgery has its unique features comparing with non-cardiac surgery, including CPB, aorta cross-clamping, and high rates and volumes of exogenous blood product transfusion, which may increase the risk of AKI4. Several risk tools have been developed to predict postoperative AKI after cardiac surgery, such as the Cleveland Clinic score[5], the Metha score[6], the Simplified Renal Index score[7] and the Birnie score[8]. It is necessary to further investigate the association between fibrinogen concentrate and adverse outcomes of patients undergoing cardiac surgery, especially the association between preoperative baseline serum fibrinogen and postoperative AKI. The purpose of the present study was to explore the association between the preoperative serum fibrinogen level and risk of postoperative AKI in patients with cardiac valve replacement surgery
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