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Incidence, risk factors and prognosis of changes in serum creatinine early after aortic abdominal surgery

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Abstract

Objective

To determine the incidence, risk factors, and prognostic implications of serum creatinine changes following major vascular surgery.

Design

Observational study.

Settings

University hospital.

Patients

Cohort of 599 consecutive patients undergoing elective abdominal aortic surgery.

Interventions

Review of prospectively collected data from 1993 to 2004.

Measurements and results

The receiver-operator characteristic (ROC) curve analysis was used to detect the best threshold for postoperative elevation in serum creatinine (Δ Creat) in relation to major complications. A cut-off value of +0.5 mg/dl was selected to define renal dysfunction (RD0.5 group, n = 91; no RD0.5, n = 508) that was associated with higher mortality (7.7% in RD0.5 group vs 1.4% in no RD0.5 group, P < 0.05), rate of admission to the ICU (34% vs 13%, P < 0.05), and incidence of cardiovascular (9% vs 4%, P < 0.05), respiratory (21% vs 7%, P < 0.05), surgical (24% vs 10%, P < 0.05), and septic complications (9% vs 3%, P < 0.05).

After multivariate analysis with logistic regression, renal dysfunction was independently related to low preoperative creatinine clearance [< 40 ml/min; odds ratio (OR) 1.5, 95% confidence interval (CI) 1.1–3.9], prolonged renal ischemic time (> 40 min; OR, 3.8, 95% CI, 1.9–7.2), blood transfusion (> 5 units; OR, 1.9, 95% CI 1.2–6.1), and rhabdomyolysis (OR, 3.6, 95% CI 1.7–7.9).

Conclusions

Postoperative RD0.5 (Δ Creat  > 0.5 mg/dl) occurs in 15% of vascular patients and carries a bad prognosis. Preoperative renal insufficiency and factors related to the complexity of surgery are the main predictors of renal dysfunction.

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Author information

Authors and Affiliations

  1. Anesthetics and Critical Care, University Hospital, rue Micheli-Ducrest, 1211, Genève 14, Switzerland

    Christoph Ellenberger, Alexandre Schweizer, John Diaper & Marc Licker

  2. Department of Cardiovascular Surgery, University Hospital, 1211, Geneva 14, Switzerland

    Afksendiyos Kalangos, Nicolas Murith, Gregory Katchatourian & Aristote Panos

Authors
  1. Christoph Ellenberger
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  2. Alexandre Schweizer
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  3. John Diaper
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  4. Afksendiyos Kalangos
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  5. Nicolas Murith
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  6. Gregory Katchatourian
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  7. Aristote Panos
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  8. Marc Licker
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Corresponding author

Correspondence to Marc Licker.

Appendix

Appendix

Definitions of major non-fatal complications

Cardiovascular

  1. 1.

    Myocardial infarct: typical rise and fall of CPK (> 120 U/l) and CK-MB/CPK ≥ 6% or troponin-I ≥ 1.5 ng/ml with at least one of the following criteria: ischemic symptoms, development of pathological Q waves on the ECG, ST segment elevation or depression (≥ 1 mm) or coronary artery intervention

  2. 2.

    Arrhythmias: supraventricular and ventricular tachyarrhythmias on ECG requiring anti-arrhythmic medications and/ or an electrical cardioversion

  3. 3.

    Congestive heart failure: need for sympathomimetic support, diuretics, or vasodilators consistent with clinical, hemodynamic (pulmonary artery pressure ≥ 15 mmHg), and radiological evidence of pulmonary congestion

Cerebral

Stroke: focal neurological deficit (transient or permanent)

Respiratory

  1. 1.

    Atelectasis: lobar collapse (chest X-rays), need for CPAP and/or bronchoscopy

  2. 2.

    Bronchopneumonia: temperature > 38°C, hyperleukocytosis (neutrophils), new lung infiltration (chest X-rays), positive culture (bronchial secretions or alveolar fluid)

  3. 3.

    Prolonged mechanical ventilation ≥ 24 h

Surgical

  1. 1.

    Re-operation for bleeding

  2. 2.

    Re-operation for ischemia

Sepsis

Systemic inflammatory response syndrome (SIRS) associated with an infection (positive culture of blood, urine, bronchoalveolar lavage fluid or other internal fluid specimen):

  • Body temperature < 35.6° or > 38.3°C

  • Tachycardia (> 90 beats/min)

  • Ventilatory frequency > 20 bpm or PaCO2 < 4.3 kPa

  • White blood cells > 12 × 109/l or < 4 × 109/l, or 10% immature neutrophils

Rhabdomyolysis

Creatine phosphokinase (CPK) value > 1700 U/l, corresponding to the mean value +2 SD of maximum CPK value observed after peripheral vascular surgery in our institution, in the absence of myocardial infarct (see above).

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Ellenberger, C., Schweizer, A., Diaper, J. et al. Incidence, risk factors and prognosis of changes in serum creatinine early after aortic abdominal surgery. Intensive Care Med 32, 1808–1816 (2006). https://doi.org/10.1007/s00134-006-0308-1

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  • DOI: https://doi.org/10.1007/s00134-006-0308-1

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