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Griffin BR, Teixeira JP, Ambruso S, Bronsert M, Pal JD, Cleveland JC, Reece TB, Fullerton DA, Faubel S, Aftab M. Stage 1 acute kidney injury is independently associated with infection following cardiac surgery. J Thorac Cardiovasc Surg 2019; 161:1346-1355.e3. [PMID: 32007252 DOI: 10.1016/j.jtcvs.2019.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Severe acute kidney injury (AKI) is a known risk factor for infection and mortality. However, whether stage 1 AKI is a risk factor for infection has not been evaluated in adults. We hypothesized that stage 1 AKI following cardiac surgery would independently associate with infection and mortality. METHODS In this retrospective propensity score-matched study, we evaluated 1620 adult patients who underwent nonemergent cardiac surgery at the University of Colorado Hospital from 2011 to 2017. Patients who developed stage 1 AKI by Kidney Disease Improving Global Outcomes creatinine criteria within 72 hours of surgery were matched to patients who did not develop AKI. The primary outcome was an infection, defined as a new surgical-site infection, positive blood or urine culture, or development of pneumonia. Secondary outcomes included in-hospital mortality, stroke, and intensive care unit (ICU) and hospital length of stay (LOS). RESULTS Stage 1 AKI occurred in 293 patients (18.3%). Infection occurred in 20.9% of patients with stage 1 AKI compared with 8.1% in the no-AKI group (P < .001). In propensity-score matched analysis, stage 1 AKI independently associated with increased infection (odds ratio [OR]; 2.24, 95% confidence interval [CI], 1.37-3.17), ICU LOS (OR, 2.38; 95% CI, 1.71-3.31), and hospital LOS (OR, 1.30; 95% CI, 1.17-1.45). CONCLUSIONS Stage 1 AKI is independently associated with postoperative infection, ICU LOS, and hospital LOS. Treatment strategies focused on prevention, early recognition, and optimal medical management of AKI may decrease significant postoperative morbidity.
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Affiliation(s)
- Benjamin R Griffin
- Division of Nephrology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - J Pedro Teixeira
- Division of Critical Care, Department of Medicine, Washington University, St Louis, Mo
| | - Sophia Ambruso
- Division of Nephrology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Michael Bronsert
- Adult and Child Consortium for Health Outcomes Research and Delivery Science and Surgical Outcomes and Applied Research, University of Colorado, Aurora, Colo
| | - Jay D Pal
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo; Rocky Mountain Regional VA Medical Center, Aurora, Colo
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo; Rocky Mountain Regional VA Medical Center, Aurora, Colo
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo; Rocky Mountain Regional VA Medical Center, Aurora, Colo
| | - David A Fullerton
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo; Rocky Mountain Regional VA Medical Center, Aurora, Colo
| | - Sarah Faubel
- Division of Nephrology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo; Rocky Mountain Regional VA Medical Center, Aurora, Colo
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo; Rocky Mountain Regional VA Medical Center, Aurora, Colo.
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