期刊
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
卷 161, 期 4, 页码 1346-+出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jtcvs.2019.11.004
关键词
acute kidney injury; postoperative infection; cardiopulmonary bypass; postoperative complications; propensity-score matching; cardiac surgery
资金
- Division of Cardiothoracic Surgery Faculty Seed grant, Anschutz Medical Campus, University of Colorado, Aurora, Colo, United States
- National Institutes of Health, United States [T32 DK 007135]
This study aimed to investigate the association between stage 1 AKI after surgery and postoperative infection and mortality. The results showed that stage 1 AKI was independently associated with increased infection, ICU LOS, and hospital LOS. Treatment strategies focusing on AKI prevention, early recognition, and optimal medical management may reduce significant postoperative morbidity.
Objectives: Severe acute kidney injury (AKI) is a known risk factor for infection and mortality. However, whether stage 1 AKI is a risk factor for infection has not been evaluated in adults. We hypothesized that stage 1 AKI following cardiac surgery would independently associate with infection and mortality. Methods: In this retrospective propensity score-matched study, we evaluated 1620 adult patients who underwent nonemergent cardiac surgery at the University of Colorado Hospital from 2011 to 2017. Patients who developed stage 1 AKI by Kidney Disease Improving Global Outcomes creatinine criteria within 72 hours of surgery were matched to patients who did not develop AKI. The primary outcome was an infection, defined as a new surgical-site infection, positive blood or urine culture, or development of pneumonia. Secondary outcomes included in-hospital mortality, stroke, and intensive care unit (ICU) and hospital length of stay (LOS). Results: Stage 1 AKI occurred in 293 patients (18.3%). Infection occurred in 20.9% of patients with stage 1 AKI compared with 8.1% in the no-AKI group (P < .001). In propensity-score matched analysis, stage 1 AKI independently associated with increased infection (odds ratio [OR]; 2.24, 95% confidence interval [CI], 1.37-3.17), ICU LOS (OR, 2.38; 95% CI, 1.71-3.31), and hospital LOS (OR, 1.30; 95% CI, 1.17-1.45). Conclusions: Stage 1 AKI is independently associated with postoperative infection, ICU LOS, and hospital LOS. Treatment strategies focused on prevention, early recognition, and optimal medical management of AKI may decrease significant postoperative morbidity.
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