Ellenberger Christoph, Schweizer Alexandre, Diaper John, Kalangos Afksendiyos, Murith Nicolas, Katchatourian Gregory, Panos Aristote, Licker Marc
Anesthetics and Critical Care, University Hospital, rue Micheli-Ducrest, 1211, Genève 14, Switzerland.
Intensive Care Med. 2006 Nov;32(11):1808-16. doi: 10.1007/s00134-006-0308-1. Epub 2006 Aug 8.
To determine the incidence, risk factors, and prognostic implications of serum creatinine changes following major vascular surgery.
Observational study.
University hospital.
Cohort of 599 consecutive patients undergoing elective abdominal aortic surgery.
Review of prospectively collected data from 1993 to 2004.
The receiver-operator characteristic (ROC) curve analysis was used to detect the best threshold for postoperative elevation in serum creatinine (Delta Creat) in relation to major complications. A cut-off value of +0.5 mg/dl was selected to define renal dysfunction (RD(0.5) group, n=91; no RD(0.5), n=508) that was associated with higher mortality (7.7% in RD(0.5) group vs 1.4% in no RD(0.5) group, P<0.05), rate of admission to the ICU (34% vs 13%, P<0.05), and incidence of cardiovascular (9% vs 4%, P<0.05), respiratory (21% vs 7%, P<0.05), surgical (24% vs 10%, P<0.05), and septic complications (9% vs 3%, P<0.05). After multivariate analysis with logistic regression, renal dysfunction was independently related to low preoperative creatinine clearance [<40 ml/min; odds ratio (OR) 1.5, 95% confidence interval (CI) 1.1-3.9], prolonged renal ischemic time (>40 min; OR, 3.8, 95% CI, 1.9-7.2), blood transfusion (>5 units; OR, 1.9, 95% CI 1.2-6.1), and rhabdomyolysis (OR, 3.6, 95% CI 1.7-7.9).
Postoperative RD(0.5) (Delta Creat >0.5 mg/dl) occurs in 15% of vascular patients and carries a bad prognosis. Preoperative renal insufficiency and factors related to the complexity of surgery are the main predictors of renal dysfunction.
