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Impact of urgent coronary artery bypass grafting on acute kidney injury

A matched cohort study

Akutes Nierenversagen nach dringlicher oder elektiver Bypassoperation

Eine gematchte Kohortenstudie

Abstract

Objectives

There is limited knowledge regarding the specific interrelationships between urgent coronary artery bypass graft (U-CABG) surgery and postoperative acute kidney injury (AKI). We aimed to (1) analyze the impact of urgent CABG (U-CABG) on the incidence and severity of postoperative AKI, (2) estimate the influence of AKI after U‑CABG or elective CABG (E-CABG) on mortality and (3) identify risk factors for AKI depending on the urgency of operation.

Results

U‑CABG patients showed a higher incidence of AKI (49.8% vs. E‑CABG: 39.7%; p = 0.026), especially for higher AKI stages 2 + 3. In-hospital mortality was higher in U‑CABG patients (12.6%) compared to E‑CABG patients (2.3%; p < 0.001). The impact of AKI on mortality did not differ, but showed a strong coherency between higher AKI stages (2 + 3) and mortality (stage 1: OR 2.409, 95% CI 1.017–5.706; p = 0.046 vs. stage 2 + 3: OR 5.577; 95% CI 2.033–15.3; p = 0.001). Univariate logistic regression analysis revealed that preoperative renal impairment, peripheral vascular disease and transfusion of more than two red blood cell concentrates were predictors for postoperative AKI in both groups.

Conclusions

U‑CABG is a risk factor for postoperative AKI and even “mild” AKI leads to a significantly higher mortality. Hence, the prevention of modifiable risk factors might reduce the incidence of postoperative AKI and thus improve outcome.

Zusammenfassung

Hintergrund

Patienten mit dringlicher Indikation zur operativen Myokardrevaskularisation („urgent CABG“; U‑CABG) stellen aufgrund der zugrunde liegenden Pathophysiologie und des erhöhten perioperativen Risikos eine besondere Patientenklientel dar. Bezüglich der Charakterisierung einer auftretenden postoperativen Nierenfunktionseinschränkung in dieser Patientenpopulation ist wenig bekannt. Ziel der Vorliegenden Analyse war die Charakterisierung der Inzidenz und des Schweregrads einer postoperativen Nierenfunktionseinschränkung nach dringlicher aortokoronarer Bypassoperation.

Ergebnisse

Im Vergleich zu Patienten nach einer elektiven operativen Myokardrevaskularisation (elektiver CABG; E‑CABG) zeigten U‑CABG-Patienten eine signifikant höhere Inzidenz einer postoperativen akuten Nierenschädigung („acute kidney injury“, AKI) mit 49,8 % gegenüber 39,7 % nach E‑CABG (p = 0,026). Der Einfluss eines AKI auf die postoperative Mortalität war in den verglichenen Gruppen nicht unterschiedlich. Es zeigte sich allerdings ein deutlicher Zusammenhang zwischen höheren AKI-Stadien und einer erhöhten Mortalität (Stadium 1: OR 2,409, 95 %-KI 1,017–5,706; p = 0,046 vs. Stadium 2 und 3: OR 5,577; 95 %-KI 2,033–15,3; p = 0,001). In der univariaten logistischen Regressionsanalyse waren eine präoperative Nierenfunktionseinschränkung, das Vorhandensein einer peripheren arteriellen Verschlusskrankheit und die Transfusion von mehr als 2 Erythrozytenkonzentraten Risikofaktoren für das Auftreten eines postoperativen AKI.

Schlussfolgerung

Patienten mit dringlicher Indikation zur operativen Myokardrevaskularisation zeigen ein erhöhtes Risiko für das Auftreten einer postoperativen Nierenfunktionsstörung, die wiederum mit einem erhöhten Mortalitätsrisiko assoziiert ist. Hinsichtlich einer möglichen Prävention kommt insbesondere den modifizierbaren Risikofaktoren eine besondere Bedeutung zu.

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Affiliations

Authors

Corresponding author

Correspondence to M. Scherner MD.

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Conflict of interest

M. Scherner, C. Weber, H. Schmidt, K. Kuhr, S. Hamacher, A. Sabashnikov, K. Eghbalzadeh, N. Mader, T. Wahlers and J. Wippermann declare that they have no competing interests.

This study was approved by our Institutional Review Board. Individual informed consent was waived due to retrospective analysis of existing patient data. All studies mentioned were in accordance with the ethical standards indicated in each case.

Additional information

M. Scherner and C. Weber contributed equally to this work.

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M. Buerke, Siegen

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Scherner, M., Weber, C., Schmidt, H. et al. Impact of urgent coronary artery bypass grafting on acute kidney injury. Med Klin Intensivmed Notfmed (2021). https://doi.org/10.1007/s00063-020-00769-x

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Keywords

  • Incidence
  • Serum creatinine
  • Mortality
  • Creatine kinase
  • Peripheral vascular disease

Schlüsselwörter

  • Inzidenz
  • Serumkreatinin
  • Mortalität
  • Kreatinkinase
  • Periphere Gefäßerkrankung