Impact Of Acute Kidney Injury After Cardiac Surgery On Short-term Outcomes
Giuseppe Petrone, Paolo Pisani, Giulio Tessitore, Luca Sandrelli, Mario Fabbrocini.
Policlinico di Monza - Heart Centre - Cittą di Alessandria, Alessandria, Italy.
OBJECTIVE: Post-operative mild renal impairment may impact mortality and morbidity after valve surgery.
METHODS: We retrospective reviewed data between January 2014 and December 2015 on 342 consecutive patients in a single institution undergoing aortic and/or mitral valve surgery with CPB with a preoperative serum creatinine <1.47 mg/dl.
RESULTS: The incidence of acute kidney injury (AKI) was 19.2 %. The following variables were independent predictors of kidney injury: age>62 years, ejection fraction <45%, pre-operative pro-calcitonin >2.8 + 6.8 ng/ml, haematocrit during CPB < 27.1 + 3.9, lactate during surgery >2.72 + 1.8 mmol/l. AKI patients had higher in hospital mortality (16.6% versus 2.1%, p = 0.01), longer duration of mechanical ventilation (39.8 ± 118.0 versus 15.2 ± 41.7 hours, p < 0.001) and higher incidence of neurologic dysfunction (21.2% versus 6.8%, p < 0.001) compared to non-AKI patients. Preoperative mild renal dysfunction adversely affected the short term 30-60 days survival (77.3% versus 92.4%; P 0.001).
CONCLUSIONS: In our experience, preoperative pro-calcitonin and lactate during surgery were very powerful predictors of in-hospital outcomes influencing an higher incidence of complications including AKI. Patients with hyper-lactate during CPB are suffering from a sort of masked circulatory shock,which will exert its deleterious effects on different organs (mainly on renal function) during the early phases of the postoperative course. Our study suggests that patients with mild renal dysfunction are at risk of increased postoperative mortality and morbidity and the analyzed intra-operative variables strongly influence the clinical course of these patients.
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