Acute Kidney Injury and Risk of Death After Elective Surgery

Prospective Analysis of Data From an International Cohort Study

International Surgical Outcomes Study (ISOS) Group

Research output: Contribution to journalArticleResearchpeer-review

2 Citations (Scopus)

Abstract

BACKGROUND: Postoperative acute kidney injury (AKI) is associated with a high mortality rate. However, the relationship among AKI, its associations, and mortality is not well understood. METHODS: Planned analysis of data was collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. AKI was defined using Kidney Disease Improving Global Outcomes criteria. Patients missing preoperative creatinine data were excluded. We used multivariable logistic regression to examine the relationships among preoperative creatinine-based estimated glomerular filtration rate (eGFR), postoperative AKI, and hospital mortality, accounting for the effects of age, major comorbid diseases, and nature and severity of surgical intervention on outcomes. We similarly modeled preoperative associations of AKI. Data are presented as n (%) or odds ratios (ORs) with 95% confidence intervals. RESULTS: A total of 36,357 patients were included, 743 (2.0%) of whom developed AKI with 73 (9.8%) deaths in hospital. AKI affected 73 of 196 (37.2%) of all patients who died. Mortality was strongly associated with the severity of AKI (stage 1: OR, 2.57 [1.3-5.0]; stage 2: OR, 8.6 [5.0-15.1]; stage 3: OR, 30.1 [18.5-49.0]). Low preoperative eGFR was strongly associated with AKI. However, in our model, lower eGFR was not associated with increasing mortality in patients who did not develop AKI. Conversely, in older patients, high preoperative eGFR (>90 mL·minute·1.73 m) was associated with an increasing risk of death, potentially reflecting poor muscle mass. CONCLUSIONS: The occurrence and severity of AKI are strongly associated with risk of death after surgery. However, the relationship between preoperative renal function as assessed by serum creatinine-based eGFR and risk of death dependent on patient age and whether AKI develops postoperatively.

Original languageEnglish
Pages (from-to)1022-1029
Number of pages8
JournalAnesthesia and Analgesia
Volume128
Issue number5
DOIs
Publication statusPublished - 1 May 2019

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Acute Kidney Injury
Cohort Studies
Glomerular Filtration Rate
Odds Ratio
Creatinine
Mortality
Kidney Diseases
Hospital Mortality
Logistic Models
Confidence Intervals
Kidney
Muscles

Cite this

International Surgical Outcomes Study (ISOS) Group. / Acute Kidney Injury and Risk of Death After Elective Surgery : Prospective Analysis of Data From an International Cohort Study. In: Anesthesia and Analgesia. 2019 ; Vol. 128, No. 5. pp. 1022-1029.
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title = "Acute Kidney Injury and Risk of Death After Elective Surgery: Prospective Analysis of Data From an International Cohort Study",
abstract = "BACKGROUND: Postoperative acute kidney injury (AKI) is associated with a high mortality rate. However, the relationship among AKI, its associations, and mortality is not well understood. METHODS: Planned analysis of data was collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. AKI was defined using Kidney Disease Improving Global Outcomes criteria. Patients missing preoperative creatinine data were excluded. We used multivariable logistic regression to examine the relationships among preoperative creatinine-based estimated glomerular filtration rate (eGFR), postoperative AKI, and hospital mortality, accounting for the effects of age, major comorbid diseases, and nature and severity of surgical intervention on outcomes. We similarly modeled preoperative associations of AKI. Data are presented as n ({\%}) or odds ratios (ORs) with 95{\%} confidence intervals. RESULTS: A total of 36,357 patients were included, 743 (2.0{\%}) of whom developed AKI with 73 (9.8{\%}) deaths in hospital. AKI affected 73 of 196 (37.2{\%}) of all patients who died. Mortality was strongly associated with the severity of AKI (stage 1: OR, 2.57 [1.3-5.0]; stage 2: OR, 8.6 [5.0-15.1]; stage 3: OR, 30.1 [18.5-49.0]). Low preoperative eGFR was strongly associated with AKI. However, in our model, lower eGFR was not associated with increasing mortality in patients who did not develop AKI. Conversely, in older patients, high preoperative eGFR (>90 mL·minute·1.73 m) was associated with an increasing risk of death, potentially reflecting poor muscle mass. CONCLUSIONS: The occurrence and severity of AKI are strongly associated with risk of death after surgery. However, the relationship between preoperative renal function as assessed by serum creatinine-based eGFR and risk of death dependent on patient age and whether AKI develops postoperatively.",
author = "{International Surgical Outcomes Study (ISOS) Group} and Hannan Chaudery and Neil MacDonald and Tahania Ahmad and Susilo Chandra and Aida Tantri and Velayuthapillai Sivasakthi and Marzida Mansor and Ricardo Matos and Pearse, {Rupert M.} and Prowle, {John R.}",
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Acute Kidney Injury and Risk of Death After Elective Surgery : Prospective Analysis of Data From an International Cohort Study. / International Surgical Outcomes Study (ISOS) Group.

In: Anesthesia and Analgesia, Vol. 128, No. 5, 01.05.2019, p. 1022-1029.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Acute Kidney Injury and Risk of Death After Elective Surgery

T2 - Prospective Analysis of Data From an International Cohort Study

AU - International Surgical Outcomes Study (ISOS) Group

AU - Chaudery, Hannan

AU - MacDonald, Neil

AU - Ahmad, Tahania

AU - Chandra, Susilo

AU - Tantri, Aida

AU - Sivasakthi, Velayuthapillai

AU - Mansor, Marzida

AU - Matos, Ricardo

AU - Pearse, Rupert M.

AU - Prowle, John R.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - BACKGROUND: Postoperative acute kidney injury (AKI) is associated with a high mortality rate. However, the relationship among AKI, its associations, and mortality is not well understood. METHODS: Planned analysis of data was collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. AKI was defined using Kidney Disease Improving Global Outcomes criteria. Patients missing preoperative creatinine data were excluded. We used multivariable logistic regression to examine the relationships among preoperative creatinine-based estimated glomerular filtration rate (eGFR), postoperative AKI, and hospital mortality, accounting for the effects of age, major comorbid diseases, and nature and severity of surgical intervention on outcomes. We similarly modeled preoperative associations of AKI. Data are presented as n (%) or odds ratios (ORs) with 95% confidence intervals. RESULTS: A total of 36,357 patients were included, 743 (2.0%) of whom developed AKI with 73 (9.8%) deaths in hospital. AKI affected 73 of 196 (37.2%) of all patients who died. Mortality was strongly associated with the severity of AKI (stage 1: OR, 2.57 [1.3-5.0]; stage 2: OR, 8.6 [5.0-15.1]; stage 3: OR, 30.1 [18.5-49.0]). Low preoperative eGFR was strongly associated with AKI. However, in our model, lower eGFR was not associated with increasing mortality in patients who did not develop AKI. Conversely, in older patients, high preoperative eGFR (>90 mL·minute·1.73 m) was associated with an increasing risk of death, potentially reflecting poor muscle mass. CONCLUSIONS: The occurrence and severity of AKI are strongly associated with risk of death after surgery. However, the relationship between preoperative renal function as assessed by serum creatinine-based eGFR and risk of death dependent on patient age and whether AKI develops postoperatively.

AB - BACKGROUND: Postoperative acute kidney injury (AKI) is associated with a high mortality rate. However, the relationship among AKI, its associations, and mortality is not well understood. METHODS: Planned analysis of data was collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. AKI was defined using Kidney Disease Improving Global Outcomes criteria. Patients missing preoperative creatinine data were excluded. We used multivariable logistic regression to examine the relationships among preoperative creatinine-based estimated glomerular filtration rate (eGFR), postoperative AKI, and hospital mortality, accounting for the effects of age, major comorbid diseases, and nature and severity of surgical intervention on outcomes. We similarly modeled preoperative associations of AKI. Data are presented as n (%) or odds ratios (ORs) with 95% confidence intervals. RESULTS: A total of 36,357 patients were included, 743 (2.0%) of whom developed AKI with 73 (9.8%) deaths in hospital. AKI affected 73 of 196 (37.2%) of all patients who died. Mortality was strongly associated with the severity of AKI (stage 1: OR, 2.57 [1.3-5.0]; stage 2: OR, 8.6 [5.0-15.1]; stage 3: OR, 30.1 [18.5-49.0]). Low preoperative eGFR was strongly associated with AKI. However, in our model, lower eGFR was not associated with increasing mortality in patients who did not develop AKI. Conversely, in older patients, high preoperative eGFR (>90 mL·minute·1.73 m) was associated with an increasing risk of death, potentially reflecting poor muscle mass. CONCLUSIONS: The occurrence and severity of AKI are strongly associated with risk of death after surgery. However, the relationship between preoperative renal function as assessed by serum creatinine-based eGFR and risk of death dependent on patient age and whether AKI develops postoperatively.

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U2 - 10.1213/ANE.0000000000003923

DO - 10.1213/ANE.0000000000003923

M3 - Article

VL - 128

SP - 1022

EP - 1029

JO - Anesthesia and Analgesia

JF - Anesthesia and Analgesia

SN - 0003-2999

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