Elevated Pulse Pressure in Anesthetized Subjects Before Cardiopulmonary Bypass Is Associated Strongly With Postoperative Acute Kidney Injury Stage

TY - JOUR

T1 - Elevated Pulse Pressure in Anesthetized Subjects Before Cardiopulmonary Bypass Is Associated Strongly With Postoperative Acute Kidney Injury Stage

AU - Mitrev, Ludmil

AU - Speich, Kelly G.

AU - Ng, Spencer

AU - Shapiro, Albina

AU - Ben-Jacob, Talia

AU - Khan, Majid

AU - Nagubandi, Vineeth

AU - Gaughan, John

N1 - Publisher Copyright: © 2019 Elsevier Inc.

PY - 2019/6

Y1 - 2019/6

N2 - Objective: To investigate whether pulse pressure (PP) in anesthetized patients undergoing cardiac surgery before and after cardiopulmonary bypass (CPB) is associated with higher postoperative acute kidney injury (AKI) stage. Design: Retrospective cohort of 597 patients undergoing cardiac surgery. Setting: Single academic health care center. Participants: Adult patients undergoing cardiac surgery requiring CPB (coronary artery bypass grafting, valve, aortic, or combined surgery). Interventions: Pulse pressure was assessed during 3 time periods: pre- and post-CPB, and in the first postoperative hour in the intensive care unit. Pulse pressure, patient characteristics, and intraoperative variables were evaluated using univariable generalized estimating equation analysis for a relationship with AKI stage. Significant risk factors from the univariable analysis then were evaluated in a multivariable generalized estimating equation analysis. Acute kidney injury stage was defined using the Acute Kidney Injury Network criteria. Primary Outcome: Stage of postoperative AKI. Measurements and Main Results: Intraoperative prebypass PP was associated independently and significantly with postoperative AKI stage (odds ratio 1.0107; 95% Confidence Interval, 1.0046-1.0168; p = 0.0005). For every 1-mmHg increase in PP, the odds of a higher AKI stage increased 1.07%. The 2 other periods were not found to be significant predictors of AKI stage. Conclusion: During general anesthesia prior to initiation of CPB, elevated PP is significantly predictive of postoperative AKI stage. This finding merits further research.

AB - Objective: To investigate whether pulse pressure (PP) in anesthetized patients undergoing cardiac surgery before and after cardiopulmonary bypass (CPB) is associated with higher postoperative acute kidney injury (AKI) stage. Design: Retrospective cohort of 597 patients undergoing cardiac surgery. Setting: Single academic health care center. Participants: Adult patients undergoing cardiac surgery requiring CPB (coronary artery bypass grafting, valve, aortic, or combined surgery). Interventions: Pulse pressure was assessed during 3 time periods: pre- and post-CPB, and in the first postoperative hour in the intensive care unit. Pulse pressure, patient characteristics, and intraoperative variables were evaluated using univariable generalized estimating equation analysis for a relationship with AKI stage. Significant risk factors from the univariable analysis then were evaluated in a multivariable generalized estimating equation analysis. Acute kidney injury stage was defined using the Acute Kidney Injury Network criteria. Primary Outcome: Stage of postoperative AKI. Measurements and Main Results: Intraoperative prebypass PP was associated independently and significantly with postoperative AKI stage (odds ratio 1.0107; 95% Confidence Interval, 1.0046-1.0168; p = 0.0005). For every 1-mmHg increase in PP, the odds of a higher AKI stage increased 1.07%. The 2 other periods were not found to be significant predictors of AKI stage. Conclusion: During general anesthesia prior to initiation of CPB, elevated PP is significantly predictive of postoperative AKI stage. This finding merits further research.

UR - https://www.scopus.com/pages/publications/85060762780

UR - https://www.scopus.com/pages/publications/85060762780#tab=citedBy

U2 - 10.1053/j.jvca.2019.01.019

DO - 10.1053/j.jvca.2019.01.019

M3 - Article

C2 - 30713052

SN - 1053-0770

VL - 33

SP - 1620

EP - 1626

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

IS - 6

ER -