Impairment of renal function in patients resuscitated from cardiac arrest: frequency, determinants and impact on outcome.
OBJECTIVE
To assess frequency, determinants, and impact on outcome of impaired renal function in cardiac arrest survivors.


METHODS
In a retrospective analysis 87 patients admitted after cardiac arrest to an emergency department between 1 March 1994 and 31 October 1995 were evaluated; patients were followed until 31 December 1998 or death. Serum creatinine was measured on arrival, 24 hours, 3 and 7 days after cardiac arrest. Impaired renal function was subclassified according to severity differentiating in between cases with an elevation of serum creatinine level > 1.4 mg/dl to 2 mg/dl and > 2 mg/dl. We examined the association between prearrest history and CPR data, collected according to the "Utstein Style", and renal function.


RESULTS
Patients were followed for a median of 1199 days (IQR 16 to 1427). Impaired renal function (serum creatinine level > 1.4 mg/dl) was found on admission in 36 patients (41%), at 24 hours in 24 (31%), at 3 days in 13 (19%) and on day seven in 9 patients (16%) respectively. History of congestive heart failure and duration of low flow state (from the beginning of basic and/or advanced life support until restoration of spontaneous circulation) were significantly associated with elevated serum creatinine (> 1.4 mg/dl) at 24 hours after the event. The occurrence of impaired renal function was also more frequent in patients with diabetes mellitus and hypertension, but this did not reach statistical significance. The relative risk for death was 2.8 (95% confidence interval 1.3-5.8) for a serum creatinine level of > 1.4 mg/dl to 2.0 mg/dl and 5.4 (95% confidence interval 2.4-12.1) for values > 2 mg/dl.


CONCLUSIONS
Transient impaired renal function is common in patients surviving cardiac arrest. Congestive heart failure and low flow time are independent predictors for the development of impaired renal function. There is a positive association in between increased serum creatinine levels and risk of death.
Domanovits
H
H
Department of Emergency Medicine, Vienna General Hospital, University of Vienna, Austria. Hans.Domanovits@akh-wien.ac.at
Müllner
M
M
Sterz
F
F
Schillinger
M
M
Klösch
C
C
Paulis
M
M
Hirschl
M M
MM
Laggner
A N
AN
D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality; D000368:Aged; D003404:Creatinine / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012151:Resuscitation; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
D003404:Creatinine