Abstract: SA-PO007

Inflammation and Malnutrition Are Predictors of Long-Term Outcomes after Postoperative AKI in Non-Cardiac Surgery

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Nishimoto, Masatoshi, Nara Medical University, Kashihara, Japan
  • Tagawa, Miho, Nara Medical University, Kashihara, Japan
  • Hamano, Takayuki, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
  • Kokubu, Maiko, Nara Medical University, Kashihara, Japan
  • Matsui, Masaru, First Department of Internal Medicine, Nara Medical University, KASHIHARA, Japan
  • Samejima, Ken-ichi, Nara Medical University, Kashihara, Japan
  • Akai, Yasuhiro, Nara Medical University, Kashihara, Japan
  • Saito, Yoshihiko, Nara Medical University, Kashihara, Japan
Background

Previous studies showed that AKI is an independent predictor of long-term mortality after adjustment for comorbidities. However, these studies did not account for inflammation and malnutrition, which is associated with increased mortality in CKD.

Methods

This is a retrospective cohort study. Inclusion criteria were adult patients who underwent non-cardiac surgery under general anesthesia from 2007 to 2010. Exclusion criteria were urological or obstetric surgery, missing creatinine values, and preoperative dialysis. The exposure of interest was AKI, defined by KDIGO criteria, within 1 week postoperatively. Outcome variable was all-cause mortality. Statistical analyses were performed using Kaplan-Meier curve and Cox regression model.

Results

Among 1,704 patients, 129 developed AKI. During median follow-up of 3.9 years, the mortality of patients with AKI and without AKI were 27.9%, and 14.7%, respectively. AKI was independently associated with all-cause mortality after adjustment for comorbidities. After further adjustment for C-reactive protein (CRP) and albumin, the association between AKI and mortality was not significant (Table). Among non-users of statin and users of statin, adjusted HR of mortality (AKI vs no-AKI) was 1.92 (1.32-2.81) and 0.57 (0.15-2.23), respectively.

Conclusion

Attenuation of the association between AKI and all-cause mortality by adjustment for albumin and CRP suggested that inflammation and malnutrition, which predisposing patients to AKI , are predictors of increased all-cause mortality after AKI. Anti-inflammatory agents, such as statins, may improve long-term outcome after AKI.

The association between postoperative AKI and all-cause mortality
 HR(95%C.I)
Model 11.72(1.19-2.46)
Model 1 + CRP1.59(1.10-2.31)
Model 1 + CRP + Alb1.17(0.77-1.76)

Model 1 was adjusted for age, sex, eGFR, and history of DM, hypertension, malignancy, and cardiovascular diseases.