Dimopoulos S, Zagkotsis G, Kinti C, Rouvali N, Georgopoulou M, Mavraki M, Tasouli A, Lyberopoulou E, Roussakis A, Vasileiadis I, Nanas S, Karabinis A. Incidence and peri-operative risk factors for development of acute kidney injury in patients after cardiac surgery: A prospective observational study. World J Clin Cases 2023; 11(16): 3791-3801 [PMID: 37383133 DOI: 10.12998/wjcc.v11.i16.3791]
Corresponding Author of This Article
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
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which 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: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jun 6, 2023; 11(16): 3791-3801 Published online Jun 6, 2023. doi: 10.12998/wjcc.v11.i16.3791
Table 1 Baseline demographic and clinical characteristics in all patients and according to acute kidney injury status
Total population (%)
N = 206
AKI
No AKI
P value
206 (100)
55 (26.7)
151 (73.3)
Baseline pre-operative characteristics
Gender, female
62 (30.1)
13 (23.6)
49 (32.5)
0.236
Age (yr)
70 (59-76)
74 (59–79)
68.5 (59–74)
0.039
BMI (kg/m2)
27.8 (25.2-31.3)
27.0 (24.8–30.0)
28.1 (25.4–31.5)
0.308
EuroScore II (%)
1.7 (1.09-2.9)
2.54 (1.52–4.4)
1.54 (0.94–2.4)
0.0001
Hb (gr/dL)
10.3 (9.6-11)
10.3 (9.8–10.9)
10.2 (9.5–11.0)
0.603
WBC (×103/μL)
10.3 (7.9-13.1)
11.4 (8.9–13.7)
9.5 (7.5–12.8)
0.015
Creatinine (mg/dL)
0.9 (0.8-1.1)
1.0 (0.9–1.3)
0.9 (0.8–1.1)
0.009
CKD
50 (24.3)
22 (40)
28 (18.5)
0.003
eGFR (mL/min/1.73 m2)
79.1 (60.2-89.9)
69.1 (52.3-84.2)
81.3 (63.1-90.8)
0.007
PPC
5 (2.4)
1 (1.8)
4 (2.6)
1.0
ICD
5 (2.4)
4 (7.3)
1 (0.7)
0.019
PAD
10 (4.9)
4 (7.3)
6 (4)
0.462
Thyroid disease
36 (17.5)
7 (12.7)
29 (19.2)
0.309
Stroke
3 (1.5)
1 (1.8)
2 (1.3)
1.0
Intraoperative characteristics
CPB (Extracorporeal circulation)
198 (96.1)
51 (92.7)
147 (97.4)
0.214
Duration of CPB (min), Ν = 198
112 (84-145)
121 (104–171)
106 (80–141)
0.009
Aortic cross-clamp time (min), Ν = 193
89 (59-108)
87 (67–111)
77 (56–107)
0.067
Duration of general anesthesia in surgery (min)
240 (190-300)
273 (213–350)
229 (183–300)
0.016
CABG
116 (56.3)
29 (52.7)
87 (57.6)
0.634
Heart valve repair
7 (3.4)
1 (1.8)
6 (4)
0.678
Aortic valve replacement
71 (34.5)
20 (36.4)
51 (33.8)
0.743
Mitral valve replacement
15 (7.3)
4 (7.3)
11 (7.3)
1.0
Tricuspid valve replacement
7 (3.4)
2 (3.6)
5 (3.3)
1.0
Mixed valve replacement
10 (4.9)
2 (3.6)
8 (5.3)
1.0
Aneurysm repair
23 (11.2)
5 (9.1)
18 (11.9)
0.803
Acute aortic dissection
4 (1.9)
3 (5.5)
1 (0.7)
0.059
Heart transplant
4 (1.9)
3 (5.5)
1 (0.7)
0.059
Post-operative characteristics
Duration of mechanical ventilation (min)
780 (591-1198)
1113 (777–2195)
714 (511–1020)
0.0001
Duration of sedation in ICU (min)
360 (250-600)
540 (300–810)
300 (240–480)
0.0001
Duration of sedation during and post surgery (min)
593 (480-842)
754 (540–1245)
570 (476–740)
0.0001
Fluid balance 24 h post surgery (mL)
722 (70-1418)
1090 (330–1862)
501 (11–1150)
0.001
Fluid balance 48 h post surgery (mL), (N = 146)
N (%); 146 (70.9)
46 (31.5)
100 (68.5)
0.526
-202 [(-1146) - 377]
-163 [(-1186) – 531]
-248 [(-1099) – 296]
Systolic blood pressure (mmHg)
119 (105-135)
116 (103 – 134)
120 (108–135)
0.162
Diastolic blood pressure (mmHg)
61 (55-70)
58 (54–65)
63 (55–70)
0.015
Mean arterial blood pressure (mmHg)
80 (71-88)
75 (68–84)
80 (74–89)
0.005
Vasopressors
65 (31.6)
27 (49.1)
38 (25.2)
0.002
Inotropes
130 (63.1)
41 (74.5)
89 (58.9)
0.05
Table 2 Univariate logistic regression analysis for acute kidney injury development
Variable
Exp (B)
95%CI
P value
Preoperative characteristics
Female sex
0.64
0.32–1.31
0.224
Age
1.02
0.99–1.05
0.125
BMI
0.98
0.92–1.05
0.601
EuroScore II
1.21
1.08–1.34
0.001
Hb
1.01
0.76–1.34
0.948
WBC
1.0
1.0–1.0
0.014
Creatinine
1.5
0.76–2.96
0.246
HTN
0.86
0.4–1.85
0.699
Diabetes
0.91
0.47–1.75
0.777
CKD
2.93
1.49–5.77
0.002
CAD
1.02
0.53–1.96
0.959
CHF
0.12
0.01–1.14
0.64
PCP
1.47
0.16–13.44
0.733
PAD
0.53
0.14–1.95
0.337
Thyroid disease
1.63
0.67–3.97
0.282
Stroke
0.73
0.06–8.16
0.794
Intraoperative characteristics
Duration of CPB
1.01
1.0–1.01
0.044
Aortic cross-clamp time
1.01
1.0–1.01
0.222
Duration of general anesthesia in surgery
1.0
1.0–1.01
0.031
Postoperative characteristics
Systolic blood pressure
0.99
0.97–1.01
0.181
Diastolic blood pressure
0.97
0.94–1.0
0.026
Mean arterial blood pressure
0.97
0.94–0.99
0.009
Duration of mechanical ventilation
1.043
1.02-1.066
< 0.001
Duration of sedation in ICU
1.0
1.0–1.0
0.004
Duration of sedation during and post surgery
1.0
1.0–1.0
0.003
Fluid balance 24 h post surgery
1.0
1.0–1.0
0.007
WBC
1.11
1.02–1.21
0.014
Vasopressors
0.35
0.18–0.67
0.001
Inotropes
0.49
0.25–0.98
0.042
Table 3 Receiver operating characteristics curve analysis for major predictors of acute kidney injury development
Test result variable(s)
Area under curve
SE
P value
95%CI
Lower bound
Upper bound
CKD
0.602
0.050
0.036
0.504
0.699
EuroScore II percentage (%)
0.692
0.045
0.000
0.604
0.781
Duration of ECC (min)
0.618
0.044
0.015
0.532
0.704
Duration of GA (min)
0.607
0.047
0.028
0.515
0.699
Duration of ICU sedation (min)
0.625
0.051
0.010
0.526
0.724
White blood cell (k/uL)
0.643
0.046
0.003
0.554
0.733
Vasopressors
0.610
0.049
0.024
0.514
0.706
Inotropes
0.562
0.047
0.204
0.469
0.654
Fluid balance 1st day after cardiac surgery (mL)
0.634
0.050
0.006
0.537
0.731
Table 4 Outcome characteristics of all patients and according acute kidney injury status
Outcome
AKI
No AKI
P value
Reintubation (n)
6 (10.9)
2 (1.3)
0.005
Dialysis (n)
4 (7)
0
0.005
Duration of mechanical ventilation (min)
1113 (777–2195)
714 (511–1020)
0.0001
Delirium (n)
20 (36.4)
36 (23.8)
0.001
ICU acquired weakness (n)
9 (16.4)
8 (5.3)
0.015
ICU length of stay (hours)
70 (28–129)
26 (21–51)
0.0001
Mortality (n)
2 (3.6)
1 (0.7)
0.046
Citation: Dimopoulos S, Zagkotsis G, Kinti C, Rouvali N, Georgopoulou M, Mavraki M, Tasouli A, Lyberopoulou E, Roussakis A, Vasileiadis I, Nanas S, Karabinis A. Incidence and peri-operative risk factors for development of acute kidney injury in patients after cardiac surgery: A prospective observational study. World J Clin Cases 2023; 11(16): 3791-3801