title: Perioperative increases in serum creatinine are predictive of increased 90-day mortality after coronary artery bypass graft surgery.
abstract: BACKGROUND
  Impaired renal function after coronary artery bypass graft (CABG) surgery is a key risk factor for in-hospital mortality. However, perioperative increases in serum creatinine and the association with mortality has not been well-studied. We assessed the hypothesis that perioperative increases in creatinine are associated with increased 90-day mortality.
  
  
  RESULTS
  We studied 1391 patients in northern New England undergoing CABG in 2001 and evaluated preoperative and postoperative creatinine. Patients with preoperative dialysis were excluded. Data were linked to the National Death Index to assess 90-day survival. Kaplan-Meier and log-rank techniques were used. Patients were stratified by percent increase in creatinine from baseline: <25%, 25% to 49%, 50% to 99%, > or =100%. We assessed 90-day survival and calculated adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for creatinine groups, adjusting for age and sex. Patients with the largest creatinine increases (50% to 99% or > or =100%) had significantly higher 90-day mortality compared with patients with a smaller increase (<50%; P<0.001). Adjusted HR and 95% CI confirmed patients in the higher 2 groups had an increased risk of mortality compared with the <25% (referent); however, the 25% to 49% group was not different from the referent: 1.80 (95% CI: 0.73 to 4.44), 6.57 (95% CI, 3.03 to 14.27), and 22.10 (95% CI, 11.25 to 43.39).
  
  
  CONCLUSIONS
  Patients with large creatinine increases (> or = 50%) after CABG surgery have a higher 90-day mortality compared with patients with small increases. Efforts to identify patients with impaired renal function and to preserve renal function before cardiac surgery may yield benefits for patients in the future.
authors.affiliation: Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Lebanon, NH, USA. Jeremiah.R.Brown@Dartmouth.EDU
authors.forename: Jeremiah R
authors.initials: JR
authors.lastname: Brown
authors.forename: Richard P
authors.initials: RP
authors.lastname: Cochran
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Dacey
authors.forename: Cathy S
authors.initials: CS
authors.lastname: Ross
authors.forename: Karyn S
authors.initials: KS
authors.lastname: Kunzelman
authors.forename: Robert F
authors.initials: RF
authors.lastname: Dunton
authors.forename: John H
authors.initials: JH
authors.lastname: Braxton
authors.forename: David C
authors.initials: DC
authors.lastname: Charlesworth
authors.forename: Robert A
authors.initials: RA
authors.lastname: Clough
authors.forename: Robert E
authors.initials: RE
authors.lastname: Helm
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Leavitt
authors.forename: Todd A
authors.initials: TA
authors.lastname: Mackenzie
authors.forename: Gerald T
authors.initials: GT
authors.lastname: O'Connor
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003404:Creatinine / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007677:Kidney Function Tests; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011184:Postoperative Period; D011446:Prospective Studies; D012306:Risk; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D003404:Creatinine