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Abstract: TH-PO072

The Role of Concurrent Major Complications in the Association Between AKI and Survival After Coronary Artery Bypass Grafting Surgery

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Helgason, Dadi, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
  • Helgadóttir, Sólveig, Uppsala University Hospital, Uppsala, Sweden
  • Palsson, Runolfur, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
  • Sigurdsson, Martin I., Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
  • Gudbjartsson, Tomas, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
  • Indridason, Olafur S., Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
Background

Acute kidney injury (AKI) is associated with decreased survival following coronary artery bypass grafting (CABG). In this study, we evaluated the impact of AKI and concurrent major complications on short- and long-term survival after CABG.

Methods

A retrospective study of all isolated primary CABG cases in Iceland in 2001-2013. AKI was defined by the KDIGO criteria and major postoperative complications comprised myocardial infarction, reoperation, stroke, mediastinitis, sternum dehiscence, acute respiratory distress syndrome and multiple organ failure. Patients were divided into four groups: AKI with or without major complications and non-AKI with or without major complications. Survival was plotted by Kaplan-Meier method and 30-day mortality evaluated by logistic regression. Predictors of long-term survival were only evaluated for patients without concurrent major complications using Cox regression.

Results

Of 1710 patients, 184 (11%) developed AKI. Major complications occurred in 21% of the AKI patients compared with 10% non-AKI patients (p<0.001). Overall survival was lower in patients with AKI compared with non-AKI patients (p<0.001, Figure 1). In adjusted analysis, AKI patients with major complications (OR=30.3 [95%-CI, 9.1-105.8]) and non-AKI patients with major complications (OR=11.6 [4.2-34.9]) had higher risk of 30-day mortality than non-AKI patients without major complications, while the risk of death for AKI patients without major complications was not significantly increased (OR=3.4 [0.8-13.3]). AKI was not significantly associated with 5-year mortality (HR=1.4 [0.8-2.4]). However, when the entire follow-up time (median 6 years, range, 0-13.5) was included, AKI predicted higher mortality (HR=1.6 [1.1-2.2]).

Conclusion

AKI associated with decreased survival following CABG. However, this relationship can to a great extent be explained by concurrent major complications, particularly in case of early mortality.

Figure 1. Overall unadjusted survival of AKI vs. non-AKI patients categorized based on whether they developed concurrent major complications or not.

Funding

  • Government Support - Non-U.S.