Published online Jun 6, 2023. doi: 10.12998/wjcc.v11.i16.3791
Peer-review started: February 8, 2023
First decision: March 14, 2023
Revised: March 28, 2023
Accepted: May 4, 2023
Article in press: May 4, 2023
Published online: June 6, 2023
Patients admitted to intensive care unit (ICU) after cardiac surgery develop acute kidney injury (AKI) immediately post-operation. We hypothesized that AKI occurs mainly due to perioperative risk factors and may affect outcome.
To assess peri-operative risk factors for AKI post cardiac surgery and its relationship with clinical outcome.
This was an observational single center, tertiary care setting study, which enrolled 206 consecutive patients, admitted to ICU after cardiac surgery. Patients were followed-up until ICU discharge or death, in order to determine the incidence of AKI, perioperative risk factors for AKI and its association with outcome. Univariate and multivariate logistic regression analysis was performed to assess predictor variables for AKI development.
After ICU admission, 55 patients (26.7%) developed AKI within 48 h. From the logistic regression analysis performed, high EuroScore II (OR: 1.18; 95%CI: 1.06-1.31, P = 0.003), white blood cells (WBC) pre-operatively (OR: 1.0; 95%CI: 1.0-1.0, P = 0.002) and history of chronic kidney disease (OR: 2.82; 95%CI: 1.195-6.65, P = 0.018) emerged as independent predictors of AKI among univariate predictors. AKI that developed AKI had longer duration of mechanical ventilation [1113 (777–2195) vs 714 (511–1020) min, P = 0.0001] and ICU length of stay [70 (28–129) vs 26 (21–51) h, P = 0.0001], higher rate of ICU-acquired weakness (16.4% vs 5.3%, P = 0.015), reintubation (10.9% vs 1.3%, P = 0.005), dialysis (7% vs 0%, P = 0.005), delirium (36.4% vs 23.8%, P = 0.001) and mortality (3.6% vs 0.7%, P = 0.046).
Patients present frequently with AKI after cardiac surgery. EuroScore II, WBC count and chronic kidney disease are independent predictors of AKI development. The occurrence of AKI is associated with poor outcome.
Core Tip: Acute kidney injury (AKI) may develop in patients after cardiac surgery. In this observational study we assessed the incidence, the peri-operative risk factors for AKI occurrence and its association with outcome in patients after cardiac surgery post- intensive care unit (ICU) admission. The results of the study have shown that AKI occurs frequently after cardiac surgery. EuroScore II, history of chronic kidney disease and white blood cell count are independent predictors of AKI development. The presence of AKI was associated with poor outcome in terms of mechanical ventilation duration, ICU length of stay, rate of dialysis, reintubation, ICU-acquired weakness, delirium and mortality.