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Acute kidney injury after out-of-hospital cardiac arrest: risk factors and prognosis in a large cohort

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Abstract

Purpose

Characteristics of acute kidney injury (AKI) occurring after out-of-hospital cardiac arrest (OHCA) are incompletely described. We aimed to evaluate the prevalence of AKI, identifying risk factors and assessing the impact of AKI on outcome after OHCA.

Methods

Single-center study between 2007 and 2012 in a cardiac arrest center in Paris, France. All consecutive OHCA patients with at least one weight measurement and one serum creatinine level available and treated by therapeutic hypothermia were included, except those with chronic kidney disease and those dead on arrival. AKI was defined as stage 3 of the Acute Kidney Injury Network (AKIN) classification. Main outcome was day-30 mortality. Factors associated with AKI occurrence and day-30 mortality were evaluated by logistic regression.

Results

580 patients (71.3 % male, median age 59.3 years, initial shockable rhythm in 56.9 % of cases) were included in the analysis. AKI stage 3 occurred in 280 (48.3 %) patients. Age, male gender, resuscitation duration, post-resuscitation shock, public setting, and initial rhythm were associated with AKI stage 3. AKI stage 3 was associated with a significantly higher day-30 mortality rate [OR 1.60; 95 % CI (1.05, 2.43); p = 0.03]. No independent association between AKI and neurologic outcome was observed. At day 30, 67 patients had a normal kidney function (eGFR >75 mL/min/1.73 m2), and five remained dialysis-dependent. Patients with eGFR higher than 75 mL/min/1.73 m2 at day 30 were younger and more frequently male.

Conclusion

AKI stage 3 was frequent after OHCA and was associated with poorer outcome. Improvement strategies in post-resuscitation care should consider AKI as a potential target of treatment.

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Acknowledgments

GG, LG, VL, CV, and AC designed the study. GG, LG, JC, MA, VL, and WB collected the data. GG performed the statistical analysis. GG and LG wrote the manuscript. FD, VL, LL, JPM, and AC reviewed the manuscript. GG and AC take responsibility for the integrity of the work. We thank Nancy Kentish-Barnes for her help in preparing the manuscript.

Conflicts of interest

None.

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Author notes

    Authors and Affiliations

    1. Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris 27 rue du Faubourg Saint Jacques, 75014, Paris, France

      Guillaume Geri, Lucie Guillemet, Julien Charpentier, Wulfran Bougouin, Jean-Paul Mira & Alain Cariou

    2. Emergency Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

      Florence Dumas

    3. Paris Descartes University, Paris, France

      Guillaume Geri, Florence Dumas, Wulfran Bougouin, Jean-Paul Mira & Alain Cariou

    4. Sudden Death Expertise Centre, Paris Cardiovascular Research Center, INSERM U970, Paris, France

      Guillaume Geri, Florence Dumas, Wulfran Bougouin, Lionel Lamhaut & Alain Cariou

    5. Surgical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

      Marion Antona

    6. Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

      Virginie Lemiale

    7. Intensive Care Unit, Melun Hospital, Melun, France

      Christophe Vinsonneau

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    1. Guillaume Geri
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    Correspondence to Alain Cariou.

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    G. Geri and L. Guillemet equally contributed to this work.

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    Geri, G., Guillemet, L., Dumas, F. et al. Acute kidney injury after out-of-hospital cardiac arrest: risk factors and prognosis in a large cohort. Intensive Care Med 41, 1273–1280 (2015). https://doi.org/10.1007/s00134-015-3848-4

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