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

Ellenberger, Christoph ; Schweizer, Alexandre ; Diaper, John ; Kalangos, Afksendiyos ; Murith, Nicolas ; Katchatourian, Gregory ; Panos, Aristote ; Licker, Marc

In: Intensive Care Medicine, 2006, vol. 32, no. 11, p. 1808-1816

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    Titre
    • Incidence, risk factors and prognosis of changes in serum creatinine early after aortic abdominal surgery
    Auteur
    • Ellenberger, Christoph. Anesthetics and Critical Care, University Hospital, rue Micheli-Ducrest, 1211, Genève 14, Switzerland
    • Schweizer, Alexandre. Anesthetics and Critical Care, University Hospital, rue Micheli-Ducrest, 1211, Genève 14, Switzerland
    • Diaper, John. Anesthetics and Critical Care, University Hospital, rue Micheli-Ducrest, 1211, Genève 14, Switzerland
    • Kalangos, Afksendiyos. Department of Cardiovascular Surgery, University Hospital, 1211, Geneva 14, Switzerland
    • Murith, Nicolas. Department of Cardiovascular Surgery, University Hospital, 1211, Geneva 14, Switzerland
    • Katchatourian, Gregory. Department of Cardiovascular Surgery, University Hospital, 1211, Geneva 14, Switzerland
    • Panos, Aristote. Department of Cardiovascular Surgery, University Hospital, 1211, Geneva 14, Switzerland
    • Licker, Marc. Anesthetics and Critical Care, University Hospital, rue Micheli-Ducrest, 1211, Genève 14, Switzerland
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • Intensive Care Medicine, 2006, vol. 32, no. 11, p. 1808-1816. Springer-Verlag
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:316827
    Summary
    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. Acut-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 abad prognosis. Preoperative renal insufficiency and factors related to the complexity of surgery are the main predictors of renal dysfunction