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A Mild Increase in Serum Creatinine after Surgery Is Associated with Increased Mortality
Lingyi Xu1,2, Linger Tang1,2, Xizi Zheng1,2
1Key Laboratory of Renal Disease, Renal Division, Ministry of Health of China, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing 100034, China.
Journal of Clinical Medicine
|August 29, 2024
Summary
Stage 1 acute kidney injury (AKI) is linked to higher in-hospital mortality in surgical patients. This highlights the need to adapt AKI classification for this population, especially those with reduced kidney function.
Area of Science:
- Nephrology
- Critical Care Medicine
- Surgical Outcomes
Background:
- Acute kidney injury (AKI) is a common postoperative complication, often presenting as mild stage 1.
- The association between stage 1 AKI and adverse outcomes in surgical patients remains unclear.
- Current KDIGO criteria may require adaptation for surgical populations.
Purpose of the Study:
- To investigate the association between stage 1 AKI and its substages with in-hospital mortality in adult surgical patients.
- To evaluate the impact of AKI severity and duration on mortality.
- To explore potential modifications to AKI classification in the surgical context.
Main Methods:
- Retrospective analysis of adult patients undergoing surgery from the MIMIC IV database.
- AKI diagnosis based on KDIGO creatinine criteria within 7 days post-surgery.
- Stage 1 AKI defined by absolute (1a) or relative (1b) serum creatinine increase; substages included transient and persistent AKI.
Main Results:
- Of 49,928 patients, 19.5% developed AKI, with 78.5% classified as stage 1.
- Stage 1 AKI was significantly associated with increased in-hospital mortality (aHR, 2.73).
- Stage 1b and persistent AKI showed significantly higher mortality risks, unlike stage 1a and transient AKI.
Conclusions:
- Stage 1 AKI independently correlates with increased mortality risk in surgical patients.
- The KDIGO AKI classification may need tailoring for surgical patients, especially those with pre-existing kidney dysfunction.
- Further research into AKI substages and their prognostic value is warranted.
