Recovery from acute kidney injury as a potent predictor of survival and good neurological outcome at discharge after out-of-hospital cardiac arrest

Abstract

Background Acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) is a well-known predictor for mortality. However, the natural course of AKI including recovery rate after OHCA is uncertain. This study investigated the clinical course of AKI after OHCA and determined whether recovery from AKI impacted the outcomes of OHCA. Methods This retrospective multicentre cohort study included adult OHCA patients treated with targeted temperature management (TTM) between January 2016 and December 2017. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes criteria. The primary outcome was the recovery rate after AKI and its association with survival and good neurological outcome at discharge. Results A total of 3697 OHCA patients from six hospitals were screened and 275 were finally included. AKI developed in 175/275 (64%) patients and 69/175 (39%) patients recovered from AKI. In most cases, AKI developed within three days of return of spontaneous circulation [155/175 (89%), median time to AKI development 1 (1–2) day] and patients recovered within seven days of return of spontaneous circulation [59/69 (86%), median time to AKI recovery 3 (2–7) days]. Duration of AKI was significantly longer in the AKI non-recovery group than in the AKI recovery group [5 (2–9) vs. 1 (1–5) days; P < 0.001]. Most patients were diagnosed with AKI stage 1 initially [120/175 (69%)]. However, the number of stage 3 AKI patients increased from 30/175 (17%) to 77/175 (44%) after the initial diagnosis of AKI. The rate of survival discharge was significantly higher in the AKI recovery group than in the AKI non-recovery group [45/69 (65%) vs. 17/106 (16%); P < 0.001]. Recovery from AKI was a potent predictor of survival and good neurological outcome at discharge in the multivariate analysis (adjusted odds ratio, 8.308; 95% confidence interval, 3.120–22.123; P < 0.001 and adjusted odds ratio, 36.822; 95% confidence interval, 4.097–330.926; P = 0.001). Conclusions In our cohort of adult OHCA patients treated with TTM ( n = 275), the recovery rate from AKI after OHCA was 39%, and recovery from AKI was a potent predictor of survival and good neurological outcome at discharge. Electronic supplementary material The online version of this article (10.1186/s13054-019-2535-1) contains supplementary material, which is available to authorized users.

Management of post-cardiac arrest syndrome

“…Age, epinephrine dose, cumulative fluid balance, and presence of shock were independent predictors of AKI development [37]. Recovery from AKI is a potent predictor of survival and good neurological outcome at discharge after out-of-hospital cardiac arrest [38].…”

Recovery from acute kidney injury is a potent predictor of survival and good neurological outcome at discharge after out-of-hospital cardiac arrest: Fact or fiction

“…We read with great interest the recent paper by Park et al, who conclude that recovery from acute kidney injury (AKI) is a potent predictor of survival and good neurological outcome at discharge after out-of-hospital cardiac arrest (OHCA). [ 1 ] We would like to make some comments. According to the authors, we should interpret these results carefully because the characteristics of OHCA patients are significantly different from critical care patients such as those with severe sepsis.…”

“…[ 3 ] Various factors, including the duration of ischemia, cause of cardiac arrest, OHCA interventions, and the patient’s baseline health status, could affect neurological outcomes in OHCA patients. [ 1 , 2 , 3 ] We noticed when comparing the two cohorts’ non-recovery versus AKI recovery that for AKI non recovery, age >60 years was significantly higher 64% in AKI non-recovery versus 45% in recovery group ( P value of 0.012). [ 1 ] Also, the incidence of diabetes mellitus was 35% in the non-recovery group versus 19% in the recovery group ( P value of 0.022).…”

Renal replacement therapy is independently associated with a lower risk of death in patients with severe acute kidney injury treated with targeted temperature management after out-of-hospital cardiac arrest

“…Keywords: Renal replacement therapy, Acute kidney injury, Out-of-hospital cardiac arrest, Targeted temperature management, Therapeutic hypothermia Background Acute kidney injury (AKI) develops frequently after out-of-hospital cardiac arrest (OHCA) and is associated with long-term mortality and poor neurological outcomes [1][2][3][4][5][6][7][8]. Similar to critically ill patients, increased AKI severity is associated with increased mortality in OHCA patients [2,4,9].…”

“…Similar to critically ill patients, increased AKI severity is associated with increased mortality in OHCA patients [2,4,9]. In contrast, recovery from AKI was a potent predictor of survival and good neurological outcome at discharge [5]. Mortality rates of patients with stage 3 AKI after OHCA are reported to be over 70% [2,3].…”