Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Ann Thorac Surg. 2012 Feb;93(2):570-6. doi: 10.1016/j.athoracsur.2011.11.004. Epub 2011 Dec 28.

Determinants of acute kidney injury duration after cardiac surgery: an externally validated tool.

Author information

  • 1The Dartmouth Institute for Health Policy and Clinical Practice, Section of Cardiology Dartmouth-Hitchcock Medical Center, and Dartmouth Medical School, Lebanon, New Hampshire 03756, USA. jbrown@dartmouth.edu

Abstract

BACKGROUND:

Acute kidney injury (AKI) duration after cardiac surgery is associated with poor survival in a dose-dependent manner. However, it is not known what perioperative risk factors contribute to prolonged AKI and delayed recovery. We sought to identify perioperative risk factors that predict duration of AKI, a complication that effects short and long-term survival.

METHODS:

We studied 4,987 consecutive cardiac surgery patients from 2002 through 2007. Acute kidney injury was defined as a 0.3 or greater (mg/dL) or 50% or greater increase in serum creatinine from baseline. Duration of AKI was defined by the number of days AKI was present. Stepwise multivariable negative binomial regression analysis was conducted using perioperative risk factors for AKI duration. The c-index was estimated by Kendall's tau.

RESULTS:

Acute kidney injury developed in 39% of patients with a median duration of AKI at 3 days and ranged from 1 to 108 days. Patients without AKI had a duration of 0 days. Independent predictors of AKI duration included baseline patient and disease characteristics, and operative and postoperative factors. Prediction for mean duration of AKI was developed using coefficients from the regression model and externally validated the model on 1,219 cardiac surgery patients in a separate cardiac surgery cohort (Translational Research Investigating Biomarker Endpoints-AKI). The c-index was 0.65 (p<0.001) for the derivation cohort and 0.62 (p<0.001) for the validation cohort.

CONCLUSIONS:

We identified and externally validated perioperative predictors of AKI duration. These risk factors will be useful to evaluate a patient's risk for the tempo of recovery from AKI after cardiac surgery and subsequent short and long-term survival. The levels of awareness created by working with these risk factors have implications regarding positive changes in processes of care that have the potential to decrease the incidence and mitigate AKI.

Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

PMID:
22206952
[PubMed - indexed for MEDLINE]
PMCID:
PMC3761881
Free PMC Article

Images from this publication.See all images (1)Free text

Figure 1
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science Icon for PubMed Central
    Loading ...
    Write to the Help Desk