Stroke volume variation and serum creatinine changes during abdominal aortic aneurysm surgery: a time-integrated analysis
Patients undergoing abdominal aortic aneurysm (AAA) surgery with suprarenal clamping are at high risk for acute kidney injury (AKI) and major cardiac and cerebrovascular events (MACCE). We aimed to assess whether the stroke volume variation (SVV), a measure of hemodynamic instability, is associated with AKI in hypertensive patients undergoing elective AAA surgery with suprarenal clamping.
In a cohort of 51 hypertensive patients, we performed serial measurements of SVV (n = 459) and serum creatinine (sCr) (n = 255). AKI was defined according to the KDIGO clinical practice guidelines. Data were analyzed by repeated-measures ANOVA and regression analysis of time-integrated changes of both SVV and sCr.
AKI developed in 45% of patients (stage 1: 31%; stage 2: 10%; stage 3: 2%). The diuresis during surgery (beta − 0.29 Z-score 95% [CI − 0.54, − 0.05]; p = 0.02), clamp time (beta 0.29 Z-score [0.05–0.52]; p = 0.02), and time-integrated changes in SVV from baseline to 12 h after surgery (beta 0.31 Z-score [0.03–0.60]; p = 0.03) were independent predictors of the time-integrated changes in sCr from baseline to 48 h after the end of surgery. In a model adjusted for age and sex, patients with AKI had an increased risk for MACCE during a mean follow-up of 3.5 ± 1.1 years (HR 5.53 [1.52–20.06]; p = 0.004).
SVV increases progressively during and after AAA surgery in subjects who will develop AKI. The increase of SVV precedes and predicts the rise in sCr and is a good discriminator of the development of AKI. AKI is associated with an increased long-term risk for MACCE.
KeywordsAbdominal aortic aneurysm Acute kidney injury Anesthesia Hemodynamics Hypertension
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 16.House AA, Haapio M, Lentini P et al (2010) Volume assessment in mechanically ventilated critical care patients using bioimpedance vectorial analysis, brain natriuretic Peptide, and central venous pressure. Int J Nephrol 2011:413760. https://doi.org/10.4061/2011/413760 PubMedPubMedCentralGoogle Scholar
- 26.Pearse RM, Harrison DA, MacDonald N et al; OPTIMISE Study Group. Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. JAMA. 2014;311(21):2181–2190CrossRefPubMedGoogle Scholar