Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2023; 11(16): 3791-3801
Published online Jun 6, 2023. doi: 10.12998/wjcc.v11.i16.3791
Incidence and peri-operative risk factors for development of acute kidney injury in patients after cardiac surgery: A prospective observational study
Stavros Dimopoulos, Georgios Zagkotsis, Charalambia Kinti, Niki Rouvali, Magda Georgopoulou, Mariantzela Mavraki, Androniki Tasouli, Efterpi Lyberopoulou, Antonios Roussakis, Ioannis Vasileiadis, Serafim Nanas, Andreas Karabinis
Stavros Dimopoulos, Charalambia Kinti, Niki Rouvali, Magda Georgopoulou, Mariantzela Mavraki, Androniki Tasouli, Efterpi Lyberopoulou, Antonios Roussakis, Andreas Karabinis, Department of Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
Stavros Dimopoulos, Georgios Zagkotsis, Ioannis Vasileiadis, Serafim Nanas, Department of Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens 10676, Greece
Author contributions: Dimopoulos S conceptualized and designed the study. Karabinis A supervised the study; Dimopoulos S, Zagkotsis G, Tasouli A, Vasileiadis I and Nanas S were involved in the data curation and analysis, projet administration and provided scientific review; Dimopoulos S, Kinti C, Rouvali N, Georgopoulou M, Mavraki M and Lyberopoulou E performed the research and collected the data; Dimopoulos S and Zagkotsis G wrote the paper, reviewed, edited and revised the final version of the manuscript. All authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by Ethics Committee of the Onassis Cardiac Surgery Center, Athens, Greece (Number Id: 663/12.12.19.
Informed consent statement: All study participants provided informed consent and the study was carried out in accordance with the ethical standards set by the Declaration of Helsinki.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stavros Dimopoulos, PhD, Chief Doctor, Consultant Physician-Scientist, Director, Doctor, Research Scientist, Staff Physician, Department of Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, 17674, Greece. stdimop@med.uoa.gr
Received: February 8, 2023
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
ARTICLE HIGHLIGHTS
Research background

Acute kidney injury (AKI) is a complication for patients undergoing cardiac surgery that might be associated with adverse outcome.

Research motivation

Perioperative targeted monitoring for possible AKI risk factors remains suboptimal and identification of patients at greater risk requires further investigation.

Research objectives

The study aimed to assess AKI presentation after cardiac surgery, to investigate prognostic factors for its development and its association with clinical outcome.

Research methods

This is a prospective observational single-center study that included 206 patients admitted in ICU post cardiac surgery followed-up until ICU discharge. Patients were divided in two groups, the AKI group that developed AKI within 48 h and the non-AKI group. Preoperative clinical characteristics, intra-operative factors and outcome were compared between two groups.

Research results

Patients presented frequently with AKI post cardiac surgery. High EuroScore II (P = 0.003), white blood cells (WBC) pre-operatively (P = 0.002) and history of kidney disease (P = 0.018) were independent predictors of AKI. AKI is associated with prolonged intensive care unit (ICU) stay, greater duration of mechanical ventilation and higher rate of dialysis, reintubation, ICU-acquired weakness, delirium and mortality.

Research conclusions

AKI is a frequent complication post cardiac surgery associated with poor outcome. Preoperative clinical characteristics, such as EuroScore II, preoperative WBC or presence of chronic kidney disease may help in early identification and appropriate management of patients in risk for AKI.

Research perspectives

Further investigation is necessary to assess preventive and optimal treatment strategy protocols for AKI presentation.