Baseline Pulse Pressure, Acute Kidney Injury, and Mortality After Noncardiac Surgery.

Area of Science:

• Cardiology
• Nephrology
• Perioperative Medicine

Background:

• Elevated pulse pressure (PP) is a known predictor of adverse cardiovascular outcomes and acute kidney injury (AKI) post-cardiac surgery.
• The association between baseline PP and outcomes after noncardiac surgery remains less understood.

Purpose of the Study:

• To investigate the relationship between elevated baseline pulse pressure (PP) and the occurrence of postoperative acute kidney injury (AKI).
• To determine if baseline PP is associated with 30-day mortality following noncardiac surgical procedures.

Main Methods:

• A cohort of 9125 adult patients undergoing noncardiac surgery was analyzed.
• Baseline arterial blood pressure, including PP, was recorded before anesthesia induction.
• Multivariable logistic regression was used to assess the association between baseline PP and postoperative AKI and 30-day mortality, adjusting for risk factors.

Main Results:

• The incidence of AKI was 19.8%, with 8.4% experiencing stage II and 4.2% stage III AKI.
• Elevated baseline PP was significantly associated with an increased risk of any postoperative AKI (OR per 20 mm Hg increase: 1.17).
• Baseline PP was linked to mild AKI (stage I) but not to more advanced AKI stages or 30-day mortality.

Conclusions:

• A significant association exists between elevated baseline pulse pressure and the development of postoperative AKI in patients undergoing noncardiac surgery.
• Elevated baseline PP was not found to be significantly associated with severe AKI or increased 30-day mortality in this patient group.