title: Creatinine clearance and risk of early mortality in patients undergoing coronary artery bypass grafting.
abstract: OBJECTIVE
  We sought to evaluate renal function assessed on the basis of calculated creatinine clearance as a predictor of early mortality and postoperative complications in patients undergoing coronary artery bypass grafting and to assess whether calculated creatinine clearance is superior to serum creatinine concentration in predicting early death postoperatively.
  
  
  METHODS
  Six thousand seven hundred eleven consecutive patients without dialysis-dependent renal insufficiency undergoing a first isolated coronary artery bypass grafting were included. Preoperative serum creatinine concentrations and creatinine clearance calculated by using the Cockroft-Gault formula were related to mortality within 30 days postoperatively.
  
  
  RESULTS
  There were 136 early deaths. After adjustment for age and other confounders in multivariate analyses, moderate (calculated creatinine clearance 30-60 mL/min) and severe (calculated creatinine clearance < 30 mL/min) renal insufficiency predicted early mortality (odds ratio of 2.4 [95% confidence interval, 1.2-4.8] and odds ratio of 4.8 [95% confidence interval], 1.6-13.9, respectively) compared with normal (calculated creatinine clearance > or = 90 mL/min) renal function. The area under the receiver operating characteristic curve for calculated creatinine clearance and serum creatinine concentration was 0.71 and 0.62, respectively, yielding a difference of 0.08 (P = .0004). No increased risk of mediastinitis or bleeding was observed in patients with renal insufficiency.
  
  
  CONCLUSIONS
  Moderate and severe renal insufficiency independently increase the risk of early death after coronary artery bypass grafting. Our results indicate that calculated creatinine clearance is a better predictor of early mortality postoperatively than serum creatinine concentration.
authors.affiliation: Department of Thoracic Surgery, Karolinska University Hospital, Stockholm, Sweden. martin.holzmann@karolinska.se
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Holzmann
authors.forename: Staffan
authors.initials: S
authors.lastname: Ahnve
authors.forename: Niklas
authors.initials: N
authors.lastname: Hammar
authors.forename: Lena
authors.initials: L
authors.lastname: Jörgensen
authors.forename: Kristina
authors.initials: K
authors.lastname: Klerdal
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pehrsson
authors.forename: Torbjörn
authors.initials: T
authors.lastname: Ivert
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality*; D003404:Creatinine / Q000097:blood / Q000378:metabolism*; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012372:ROC Curve; D051437:Renal Insufficiency / Q000503:physiopathology; D012307:Risk Factors
chemical_list: D003404:Creatinine