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Renal dysfunction and serious infections after open-heart surgery
Charuhas V Thakar1, Jean-Pierre Yared, Sarah Worley
1Department of Nephrology and Hypertension, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Kidney International
|June 6, 2003
Summary
Preoperative renal dysfunction and postoperative acute renal failure (ARF) increase infection risk after open-heart surgery. Preoperative kidney issues independently raise infection rates, even without ARF.
Area of Science:
- Nephrology
- Cardiothoracic Surgery
- Infectious Disease Epidemiology
Background:
- Infections and sepsis are significant causes of mortality in patients with kidney dysfunction.
- Assessing the impact of renal function on post-surgical infection is crucial for patient outcomes.
Purpose of the Study:
- To investigate the influence of preoperative renal function and postoperative acute renal failure (ARF) on the incidence of infections following open-heart surgery.
Main Methods:
- Retrospective analysis of 24,660 patients undergoing open-heart surgery (1993-2000).
- Primary outcome: occurrence of serious infections; Secondary outcome: hospital mortality.
- Multivariate analysis used to identify independent risk factors.
Main Results:
- Overall infection rate was 3.3%. Higher rates observed with lower preoperative creatinine clearance.
- Postoperative ARF significantly increased infection frequency (58.5% with dialysis vs. 23.7% without).
- Preoperative renal dysfunction was an independent risk factor for infection (OR 1.3; CI 1.1-1.6), even excluding ARF patients.
Conclusions:
- Both preoperative renal dysfunction and postoperative ARF are significant determinants of serious infections after open-heart surgery.
- Postoperative ARF elevates infection risk irrespective of baseline renal function.
- Preoperative renal dysfunction independently predicts a higher risk of infection.