Subclinical changes in serum creatinine and mortality after coronary artery bypass grafting

Tolpin, Daniel A.; Collard, Charles D.; Lee, Vei-Vei; Virani, Salim S.; Allison, Paul M.; Elayda, MacArthur A.; Pan, Wei

doi:10.1016/j.jtcvs.2011.09.044

Cited by 61 publications

(61 citation statements)

References 22 publications

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“…We excluded 268 studies: animal studies (15), reviews (42), no epidemiological data available (177), not about CRS-1 (23), no data about AKI or WRF (8) and studies evaluating a specific intervention (3). Finally, we included 64 papers (n = 509,766 patients), containing data on AKI in AHF patients (18 studies; 29,202 patients) [4,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26], ACS (15 studies; 282,113 patients) [13,27,28,29,30,31,32,33,34,35,36,37,38,39,40] and CS (32 studies; 198,451 patients) [41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72] (table 1). One study contained information about AHF as well as ACS and is therefore used in both groups [13].…”

Section: Resultsmentioning

confidence: 99%

Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis

Vandenberghe¹,

et al. 2015

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Background: We evaluated the epidemiology and outcome of acute kidney injury (AKI) in patients with cardiorenal syndrome type 1 (CRS-1) and its subgroups: acute heart failure (AHF), acute coronary syndrome (ACS) and after cardiac surgery (CS). Summary: We performed a systematic review and meta-analysis. CRS-1 was defined by AKI (based on RIFLE, AKIN and KDIGO), worsening renal failure (WRF) and renal replacement therapy (RRT). We investigated the three most common clinical causes of CRS-1: AHF, ACS and CS. Out of 332 potential papers, 64 were eligible - with AKI used in 41 studies, WRF in 25 and RRT in 20. The occurrence rate of CRS-1, defined by AKI, WRF and RRT, was 25.4, 22.4 and 2.6%, respectively. AHF patients had a higher occurrence rate of CRS-1 compared to ACS and CS patients (AKI: 47.4 vs. 14.9 vs. 22.1%), but RRT was evenly distributed among the types of acute cardiac disease. AKI was associated with an increased mortality rate (risk ratio = 5.14, 95% CI 3.81-6.94; 24 studies and 35,227 patients), a longer length of stay in the intensive care unit [LOS_ICU] (median duration = 1.37 days, 95% CI 0.41-2.33; 9 studies and 10,758 patients) and a longer LOS in hospital [LOS_hosp] (median duration = 3.94 days, 95% CI 1.74-6.15; 8 studies and 35,227 patients). Increasing AKI severity was associated with worse outcomes. The impact of CRS-1 defined by AKI on mortality was greatest in CS patients. RRT had an even greater impact compared to AKI (mortality risk ratio = 9.2, median duration of LOS_ICU = 10.6 days and that of LOS_hosp = 20.2 days). Key Messages: Of all included patients, almost one quarter developed AKI and approximately 3% needed RRT. AHF patients experienced the highest occurrence rate of AKI, but the impact on mortality was greatest in CS patients.

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Section: Resultsmentioning

confidence: 99%

Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis

Vandenberghe¹,

et al. 2015

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“…Some studies have linked minor creatinine increases to higher mortality in small subsets of cardiac surgery patients. These studies categorized patients by absolute creatinine increases, 21,34,36 by relative creatinine increase 32,37 or by AKI stages. 38,39 Although explicitly accounting for minor creatinine changes, the patients identified as "at risk" were either likely to be diagnosed as stage 1 AKI by current AKI definition or the study failed to identify all patients at risk.…”

Section: Discussionmentioning

confidence: 99%

“…2 In addition, the resemblance of our study's results to those of previous studies in smaller patient samples and in elect surgical subpopulations further supports our conclusions. [20][21][22]34,36,57 …”

Section: Author Manuscript Author Manuscriptmentioning

confidence: 99%

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

Kork

Balzer

Spies

et al. 2016

Survey of Anesthesiology

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“…The latter findings turned out to be particularly significant as several studies describe even subclinical changes in serum creatinine as an independent risk factor for all cause 30-day mortality after cardiac surgery. 2,3 A recent multicenter study revealed that perioperative creatinine levels are superior in detection of CSA-AKI in comparison with cystatin C. 38 Therefore, we chose the perioperative creatinine increase as the primary endpoint for multiple regression analyses and the subsequent power analyses. The additional analyses of the RIFLE criteria revealed also no significant genetic influence.…”

Section: Cardiac Surgery-associated Acute Kidney Injurymentioning

confidence: 99%

“…2,3 Novel biomarkers for acute renal failure are on the horizon. 4 Nevertheless, the variability in the clinical outcome makes it difficult to predict the risk for an individual patient.…”

Section: Introductionmentioning

confidence: 99%

Apolipoprotein E genotype, TNF-α 308G/A and risk for cardiac surgery associated-acute kidney injury in Caucasians

et al. 2013

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Objectives: Acute kidney injury following cardiac surgery depicts a severe clinical problem that is strongly associated with adverse short-and long-term outcome. We analyzed two common genetic polymorphisms that have previously been linked to renal failure and inflammation, and have been supposed to be associated with cardiac surgery associated-acute kidney injury (CSA-AKI). Methods: A total of 1415 consecutive patients who underwent elective cardiac surgery with CPB at our institution were prospectively enrolled. Patients were genotyped for Apolipoprotein E (ApoE E2,E3,E4) (rs429358 and rs7412) and TNF-a-308 G4A (rs1800629). Results: Demographic characteristics and procedural data revealed no significant differences between genotypes. No association between ApoE (E2,E3,E4) and TNF-a-308 G4A genotypes and the RIFLE criteria could be detected. Several multiple linear regression analyses for postoperative creatinine increase revealed highly significant associations for aortic cross clamp time (p50.001), CPB-time (p50.001), norepinephrine (p50.001), left ventricular function (p ¼ 0.004) and blood transfusion (p50.001). No associations were found for ApoE (E2,E3,E4) and TNF-a-308 G4A genotypes or baseline creatinine. When the sample size is 1415, the multiple linear regression test of R 2 ¼ 0 for seven covariates assuming normal distribution will have at least 99% power with significance level 0.05 to detect an R 2 of 0.108 or 0.107 as observed in the data. Conclusions: ApoE (E2,E3,E4) polymorphism and the TNF-a-308 G4A polymorphism are not associated with renal injury after CPB.

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Subclinical changes in serum creatinine and mortality after coronary artery bypass grafting

Abstract: Subclinical increases in serum creatinine that do not meet acute renal injury criteria are independently associated with 30-day all-cause mortality in patients with normal renal function or preoperative renal insufficiency undergoing coronary artery bypass grafting.

Cited by 61 publications

References 22 publications

Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis

Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis

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

Apolipoprotein E genotype, TNF-α 308G/A and risk for cardiac surgery associated-acute kidney injury in Caucasians

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