Perioperative Increases in Serum Creatinine Are Predictive of Increased 90-Day Mortality After Coronary Artery Bypass Graft Surgery

Abstract

Background-Impaired renal function after coronary artery bypass graft (CABG) surgery is a key risk factor for in-hospital mortality. However, perioperative increases in serum creatinine and the association with mortality has not been well-studied.We assessed the hypothesis that perioperative increases in creatinine are associated with increased 90-day mortality. Methods and Results-We studied 1391 patients in northern New England undergoing CABG in 2001 and evaluated preoperative and postoperative creatinine. Patients with preoperative dialysis were excluded. Data were linked to the National Death Index to assess 90-day survival. Kaplan-Meier and log-rank techniques were used. Patients were stratified by percent increase in creatinine from baseline: Ͻ25%, 25% to 49%, 50% to 99%, Ն100%. We assessed 90-day survival and calculated adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for creatinine groups, adjusting for age and sex. Patients with the largest creatinine increases (50% to 99% or Ն100%) had significantly higher 90-day mortality compared with patients with a smaller increase (Ͻ50%; PϽ0.001). Adjusted HR and 95% CI confirmed patients in the higher 2 groups had an increased risk of mortality compared with the Ͻ25% (referent); however, the 25% to 49% group was not different from the referent: 1.

Which method of estimating renal function is the best predictor of mortality after coronary artery bypass grafting?

“…This is in disagreement with some earlier reports [16]. This small change in serum creatinine in our patient group could be explained by the perioperative intravenous crystalloid administration protocol in our patients, which is different from that in other centres.…”

Minor Postoperative Increases of Creatinine Are Associated With Higher Mortality and Longer Hospital Length of Stay in Surgical Patients

“…This epidemiology in surgical patients is consistent with previous studies in other cohorts of hospitalized patients. [7][8][9]18,20,22,32 In contrast, the association of minor creatinine increases not fulfilling AKI criteria with adverse outcome has not been shown in noncardiac surgical patients before. Some studies have linked minor creatinine increases to higher mortality in small subsets of cardiac surgery patients.…”

“…27 Creatinine increases below KDIGO AKI criteria were dichotomized according to previous studies. [20][21][22][32][33][34] The estimated glomerular filtration rate was calculated according to the Modification of Diet in Renal Disease formula. 35 In routine clinical practice, not all patients have postoperative creatinine follow-up measurements on a daily basis, hence leading to missing data.…”

Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study

“…[1][2][3][4][5] As there are currently no clinically proven therapies that can prevent or treat AKI in cardiac surgery, 1 the best means for reducing the burden of AKI may be through risk factor modification.…”