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Postoperative Acute Kidney Injury Is an Important Determinant of Long-Term Survival of Critically Ill Patients After Vascular Surgery

Charles Hobson, Sinan Yavas, Sophie Subbiah, Mark S. Segal, Andrea Gabrielli, Curtis G. Tribble, Joseph A. Layon, Azra Bihorac.
University of Florida, Gainesville, Fla.

OBJECTIVES: Acute kidney injury (AKI) is a common occurrence in surgical intensive care units (SICU). Long-term survival of patients with postoperative AKI who survive to leave the hospital is poorly understood. Our study reports the long-term outcome of critically ill patients with no previous history of kidney disease who developed postoperative AKI according to RIFLE criteria following vascular surgery, and survived to be discharged from the hospital.

METHODS: Medical records of 1725 patients undergoing vascular surgery between 1992 and 2002 with >24 hours postoperative SICU stay who were discharged alive were reviewed and AKI was determined using RIFLE classification. Patients were stratified according to the maximum RIFLE class (class R, class I or class F) reached during their hospital stay, based on glomerular filtration rate criteria, using changes in serum creatinine concentrations.

RESULTS: AKI was identified in 660 (38%) of patients who were discharged alive. Patients with AKI were older, more likely to be female, and had more severe comorbidities compared to patients who did not develop AKI. Postoperative sepsis and prolonged mechanical ventilation were more likely to occur among patients with AKI. Length of ICU and hospital stay were significantly longer among AKI patients (3 vs. 1 days and 15 vs. 3 days, respectively, p<0.001). Although 636 (97%) of the patients with AKI had either complete or partial renal recovery at the time of discharge, their long-term survival remained inferior to patients with no AKI. The proportion of survivors at one, five and ten years following discharge among patients with AKI were 84%, 53% and 37%, respectively. Survival for patients without AKI during hospitalization at one, five and ten years following the discharge was 94%, 77%, and 55% [Figure 1 A]. Cox regression analysis confirmed AKI to be an independent predictor of poor long-term survival even when adjusted for patients’ age, gender, co-morbidities on admission, postoperative sepsis and acute respiratory failure (increased hazard for death of 1.39, CI 1.07-1.50, p<0.001).

CONCLUSIONS: We have demonstrated that postoperative AKI in patients after vascular surgery is not only an important complication in the immediate postoperative course, but also carries significant implications for long-term mortality.

AUTHOR DISCLOSURES: C. Hobson, None; S. Yavas, None; S. Subbiah, None; M.S. Segal, None; A. Gabrielli, None; C.G. Tribble, None; J.A. Layon, None; A. Bihorac, None.