Risk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery.

<h4>Background</h4>Acute Kidney Injury (AKI) represents a clinical condition with poor prognosis. The incidence of AKI in hospitalized patients was about 22-57%. Patients undergoing cardiac surgery (CS) are particularly exposed to AKI because of the related oxidative stress, inflammation...

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Autores principales:	Giuseppe Filiberto Serraino, Michele Provenzano, Federica Jiritano, Ashour Michael, Nicola Ielapi, Pasquale Mastroroberto, Michele Andreucci, Raffaele Serra
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/47ca1481dbdb49d39e3d1cefb8c4e116
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spelling	oai:doaj.org-article:47ca1481dbdb49d39e3d1cefb8c4e1162021-12-02T20:11:16ZRisk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery.1932-620310.1371/journal.pone.0252209https://doaj.org/article/47ca1481dbdb49d39e3d1cefb8c4e1162021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252209https://doaj.org/toc/1932-6203<h4>Background</h4>Acute Kidney Injury (AKI) represents a clinical condition with poor prognosis. The incidence of AKI in hospitalized patients was about 22-57%. Patients undergoing cardiac surgery (CS) are particularly exposed to AKI because of the related oxidative stress, inflammation and ischemia-reperfusion damage. Hence, the risk profile of patients undergoing CS who develop AKI and who are consequently at increased mortality risk deserves further investigation.<h4>Methods</h4>We designed a retrospective study examining consecutive patients undergoing any type of open-heart surgery from January to December 2018. Patients with a history of AKI were excluded. AKI was diagnosed according to KDIGO criteria. Univariate associations between clinical variables and AKI were tested using logistic regression analysis. Variable thresholds maximizing the association with AKI were measured with the Youden index. Multivariable logistic regression analysis was performed to assess predictors of AKI through backward selection. Mortality risk factors were assessed through the Cox proportional hazard model.<h4>Results</h4>We studied 158 patients (mean age 51.2±9.7 years) of which 74.7% were males. Types of procedures performed were: isolated coronary artery bypass (CABG, 50.6%), valve (28.5%), aortic (3.2%) and combined (17.7%) surgery. Overall, incidence of AKI was 34.2%. At multivariable analysis, young age (p = 0.016), low blood glucose levels (p = 0.028), estimated Glomerular Filtration Rate (p = 0.007), pH (p = 0.008), type of intervention (p = 0.031), prolonged extracorporeal circulation (ECC, p = 0.028) and cross-clamp (p = 0.021) times were associated with AKI. The threshold for detecting AKI were 91 and 51 minutes for ECC and cross-clamp times, respectively. At survival analysis, the presence of AKI, prolonged ECC and cross-clamp times, and low blood glucose levels forecasted mortality.<h4>Conclusions</h4>AKI is common among CS patients and associates with shortened life-expectancy. Several pre-operative and intra-operative predictors are associated with AKI and future mortality. Future studies, aiming at improving prognosis in high-risk patients, by a stricter control of these factors, are awaited.Giuseppe Filiberto SerrainoMichele ProvenzanoFederica JiritanoAshour MichaelNicola IelapiPasquale MastrorobertoMichele AndreucciRaffaele SerraPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0252209 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Giuseppe Filiberto Serraino Michele Provenzano Federica Jiritano Ashour Michael Nicola Ielapi Pasquale Mastroroberto Michele Andreucci Raffaele Serra Risk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery.
description	<h4>Background</h4>Acute Kidney Injury (AKI) represents a clinical condition with poor prognosis. The incidence of AKI in hospitalized patients was about 22-57%. Patients undergoing cardiac surgery (CS) are particularly exposed to AKI because of the related oxidative stress, inflammation and ischemia-reperfusion damage. Hence, the risk profile of patients undergoing CS who develop AKI and who are consequently at increased mortality risk deserves further investigation.<h4>Methods</h4>We designed a retrospective study examining consecutive patients undergoing any type of open-heart surgery from January to December 2018. Patients with a history of AKI were excluded. AKI was diagnosed according to KDIGO criteria. Univariate associations between clinical variables and AKI were tested using logistic regression analysis. Variable thresholds maximizing the association with AKI were measured with the Youden index. Multivariable logistic regression analysis was performed to assess predictors of AKI through backward selection. Mortality risk factors were assessed through the Cox proportional hazard model.<h4>Results</h4>We studied 158 patients (mean age 51.2±9.7 years) of which 74.7% were males. Types of procedures performed were: isolated coronary artery bypass (CABG, 50.6%), valve (28.5%), aortic (3.2%) and combined (17.7%) surgery. Overall, incidence of AKI was 34.2%. At multivariable analysis, young age (p = 0.016), low blood glucose levels (p = 0.028), estimated Glomerular Filtration Rate (p = 0.007), pH (p = 0.008), type of intervention (p = 0.031), prolonged extracorporeal circulation (ECC, p = 0.028) and cross-clamp (p = 0.021) times were associated with AKI. The threshold for detecting AKI were 91 and 51 minutes for ECC and cross-clamp times, respectively. At survival analysis, the presence of AKI, prolonged ECC and cross-clamp times, and low blood glucose levels forecasted mortality.<h4>Conclusions</h4>AKI is common among CS patients and associates with shortened life-expectancy. Several pre-operative and intra-operative predictors are associated with AKI and future mortality. Future studies, aiming at improving prognosis in high-risk patients, by a stricter control of these factors, are awaited.
format	article
author	Giuseppe Filiberto Serraino Michele Provenzano Federica Jiritano Ashour Michael Nicola Ielapi Pasquale Mastroroberto Michele Andreucci Raffaele Serra
author_facet	Giuseppe Filiberto Serraino Michele Provenzano Federica Jiritano Ashour Michael Nicola Ielapi Pasquale Mastroroberto Michele Andreucci Raffaele Serra
author_sort	Giuseppe Filiberto Serraino
title	Risk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery.
title_short	Risk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery.
title_full	Risk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery.
title_fullStr	Risk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery.
title_full_unstemmed	Risk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery.
title_sort	risk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/47ca1481dbdb49d39e3d1cefb8c4e116
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Risk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery.

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