Incidence, risk factors, and prognosis of a moderate increase in plasma creatinine early after cardiac surgery.
OBJECTIVE
To evaluate the incidence and prognosis of a moderate increase in serum creatinine early after cardiac surgery.


METHODS
Retrospective clinical study.


METHODS
Surgical intensive care unit in a university hospital.


METHODS
Five hundred and ninety-one consecutive adult patients operated on for cardiac surgery during 1 year.


METHODS
Plasma creatinine was measured systematically before and during the first 3 days after surgery. Comorbid events were assessed as organ dysfunction (cardiac, pulmonary, hematologic, and neurologic), allowing us to calculate for each patient a dysfunction score (0-5).


RESULTS
Postoperative plasma creatinine increased by > or =20% in 15.6% of patients; eight of these required dialysis. A 20% increase in plasma creatinine was associated with other organ dysfunction in 79.3% of patients. Overall mortality rate was 2.7% and increased with the dysfunction score (17.7% for a dysfunction score > or =3). Mortality rate was 12.0% for patients who had 20% increased plasma creatinine with other organ dysfunction but was 0% for patients without other organ dysfunction. A logistic regression analysis revealed that the most important prognostic factors of death were cardiac dysfunction (odds ratio, 8.5; 95% confidence interval, 2.2-32.5) and the association of renal dysfunction and hematologic dysfunction (odds ratio = 12.0; 95% confidence interval, 3.9-37.2). Mean intensive care unit stay of patients with increased plasma creatinine was significantly longer (8.1 +/- 5.6 vs. 4.3 +/- 1.4 days, p <.01) and increased significantly with the dysfunction score (p <.01). Patients with isolated increased plasma creatinine had a significantly longer stay in the intensive care unit than patients without any organ dysfunction (4.6 +/- 1.4 vs. 3.9 +/- 0.9, p <.01).


CONCLUSIONS
Our results suggest that a postoperative 20% increase in plasma creatinine after cardiac surgery is not rare and has a significant impact on postoperative outcome, mainly when multiple organ dysfunction occurs. Any preoperative reduced renal reserve or perioperative renal ischemia increases the renal risk.
Ryckwaert
Frédérique
F
Department of Anaesthesiology and Intensive Care, Hopital Arnaud de Villeneuve, 34295 Montpellier, France.
Boccara
Gilles
G
Frappier
Jean-Marc
JM
Colson
Pascal H
PH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood* / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
D003404:Creatinine