Minor Postoperative Increases of Creatinine Are Associated with Higher Mortality
and Longer Hospital Length of Stay in Surgical Patients
#MMPMID26492475
Kork F
; Balzer F
; Spies CD
; Wernecke KD
; Ginde AA
; Jankowski J
; Eltzschig HK
Anesthesiology
2015[Dec]; 123
(6
): 1301-11
PMID26492475
show ga
BACKGROUND: Surgical patients frequently experience postoperative increases in
creatinine levels. The authors hypothesized that even small increases in
postoperative creatinine levels are associated with adverse outcomes. METHODS:
The authors examined the association of postoperative changes from preoperative
baseline creatinine with all-cause in-hospital mortality and hospital length of
stay (HLOS) in a retrospective analysis of surgical patients at a single tertiary
care center between January 2006 and June 2012. RESULTS: The data of 39,369
surgical patients (noncardiac surgery n = 37,345; cardiac surgery n = 2,024) were
analyzed. Acute kidney injury (AKI)-by definition of the Kidney Disease:
Improving Global Outcome group-was associated with a five-fold higher mortality
(odds ratio [OR], 4.8; 95% CI, 4.1 to 5.7; P < 0.001) and a longer HLOS of 5 days
(P < 0.001) after adjusting for age, sex, comorbidities, congestive heart
failure, preoperative hemoglobin, preoperative creatinine, exposure to
radiocontrast agent, type of surgery, and surgical AKI risk factors. Importantly,
even minor creatinine increases (?creatinine 25 to 49% above baseline but < 0.3
mg/dl) not meeting AKI criteria were associated with a two-fold increased risk of
death (OR, 1.7; 95% CI, 1.3 to 2.4; P < 0.001) and 2 days longer HLOS (P <
0.001). This was more pronounced in noncardiac surgery patients. Patients with
minor creatinine increases had a five-fold risk of death (OR, 5.4; 95% CI, 1.5 to
20.3; P < 0.05) and a 3-day longer HLOS (P < 0.01) when undergoing noncardiac
surgery. CONCLUSIONS: Even minor postoperative increases in creatinine levels are
associated with adverse outcomes. These results emphasize the importance to find
effective therapeutic approaches to prevent or treat even mild forms of
postoperative kidney dysfunction to improve surgical outcomes.
|*Hospital Mortality
[MESH]
|Aged
[MESH]
|Creatinine/*blood
[MESH]
|Female
[MESH]
|Humans
[MESH]
|Length of Stay/*statistics & numerical data
[MESH]
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