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Creatinine elevations from baseline at the time of cardiac surgery are associated with postoperative complications
Benjamin R Griffin1, Michael Bronsert2, T Brett Reece3
1Division of Nephrology, University of Colorado Anschutz Medical Campus, Aurora, Colo.
Insights
Elevated creatinine levels before surgery indicate higher risks for patients undergoing cardiac procedures. Monitoring these changes is crucial for anticipating and managing postoperative complications, improving patient outcomes.
Area of Science:
- Nephrology
- Cardiology
- Perioperative Medicine
Background:
- Baseline kidney function is a critical determinant of postoperative morbidity and mortality.
- The clinical significance of a creatinine elevation at surgery compared to a recent lower value remains unevaluated.
- Establishing a patient's baseline creatinine is essential for accurate risk assessment.
Purpose of the Study:
- To investigate the association between creatinine elevations from baseline and adverse postoperative outcomes in cardiac surgery patients.
- To determine if a rise in creatinine preceding surgery predicts complications.
Main Methods:
- Retrospective analysis of 1486 cardiac surgery patients.
- Creatinine change calculated as presurgical value minus the lowest value within 3 months prior.
- Outcomes included mortality, infection, stroke, acute kidney injury (AKI) stage 3, and length of stay (LOS).
- Statistical adjustment using a balancing score for patient characteristics.
Main Results:
- Increased odds of postoperative infection, AKI stage 3, prolonged ICU LOS, and hospital LOS were associated with creatinine elevation.
- A 0.1 mg/dL increase in creatinine correlated with higher odds of infection (OR 1.17) and AKI stage 3 (OR 1.44).
- Unadjusted mortality showed an increase, but this was not significant after balancing score adjustment.
- No association found between creatinine elevation and postoperative stroke.
Conclusions:
- Preoperative elevations in creatinine above baseline are linked to increased postoperative morbidity in cardiac surgery.
- Heightened vigilance is recommended post-surgery when even small creatinine increases are observed.
- Routine establishment of baseline creatinine before surgery is advised for better patient management.
Objectives:
Baseline kidney function is a key predictor of postoperative morbidity and mortality. Whether an increased creatinine at the time of surgery, compared with the lowest creatinine in the 3 months before surgery, is associated with poor outcomes has not been evaluated. We examined whether creatinine elevations from "baseline" were associated with adverse postoperative outcomes.
Methods:
A total of 1486 patients who underwent cardiac surgery at the University of Colorado Hospital between January 2011 and May 2016 met inclusion criteria. "Change in creatinine from baseline" was defined as the difference between the immediate presurgical creatinine value and the lowest creatinine value within 3 months preceding surgery. Outcomes evaluated were in-hospital mortality, postoperative infection, postoperative stroke, development of stage 3 acute kidney injury, intensive care unit length of stay, and hospital length of stay. Outcomes were adjusted using a balancing score to account for differences in patient characteristics.
Results:
There were significant increases in the odds of postoperative infection (odds ratio, 1.17; confidence interval, 1.02-1.34; per 0.1 mg/dL increase in creatinine), stage 3 acute kidney injury (odds ratio, 1.44; confidence interval; 1.18-1.75), intensive care unit length of stay (odds ratio, 1.13; confidence interval, 1.01-1.26), and hospital length of stay (odds ratio, 1.09; confidence interval, 1.05-1.13). There was a significant increase in mortality in the unadjusted analysis, although not after adjustment using a balancing score. There was no association with postoperative stroke.
Conclusions:
Elevations in creatinine at the time of surgery above the "baseline" level are associated with increased postoperative morbidity. Baseline creatinine should be established before surgery, and small changes in creatinine should trigger heightened vigilance in the postoperative period.
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