title: Incidence, risk factors and prognosis of changes in serum creatinine early after aortic abdominal surgery.
abstract: OBJECTIVE
  To determine the incidence, risk factors, and prognostic implications of serum creatinine changes following major vascular surgery.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Cohort of 599 consecutive patients undergoing elective abdominal aortic surgery.
  
  
  METHODS
  Review of prospectively collected data from 1993 to 2004.
  
  
  RESULTS
  The receiver-operator characteristic (ROC) curve analysis was used to detect the best threshold for postoperative elevation in serum creatinine (Delta Creat) in relation to major complications. A cut-off value of +0.5 mg/dl was selected to define renal dysfunction (RD(0.5) group, n=91; no RD(0.5), n=508) that was associated with higher mortality (7.7% in RD(0.5) group vs 1.4% in no RD(0.5) group, P<0.05), rate of admission to the ICU (34% vs 13%, P<0.05), and incidence of cardiovascular (9% vs 4%, P<0.05), respiratory (21% vs 7%, P<0.05), surgical (24% vs 10%, P<0.05), and septic complications (9% vs 3%, P<0.05). After multivariate analysis with logistic regression, renal dysfunction was independently related to low preoperative creatinine clearance [<40 ml/min; odds ratio (OR) 1.5, 95% confidence interval (CI) 1.1-3.9], prolonged renal ischemic time (>40 min; OR, 3.8, 95% CI, 1.9-7.2), blood transfusion (>5 units; OR, 1.9, 95% CI 1.2-6.1), and rhabdomyolysis (OR, 3.6, 95% CI 1.7-7.9).
  
  
  CONCLUSIONS
  Postoperative RD(0.5) (Delta Creat >0.5 mg/dl) occurs in 15% of vascular patients and carries a bad prognosis. Preoperative renal insufficiency and factors related to the complexity of surgery are the main predictors of renal dysfunction.
authors.affiliation: Anesthetics and Critical Care, University Hospital, rue Micheli-Ducrest, 1211, Genève 14, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Ellenberger
authors.forename: Alexandre
authors.initials: A
authors.lastname: Schweizer
authors.forename: John
authors.initials: J
authors.lastname: Diaper
authors.forename: Afksendiyos
authors.initials: A
authors.lastname: Kalangos
authors.forename: Nicolas
authors.initials: N
authors.lastname: Murith
authors.forename: Gregory
authors.initials: G
authors.lastname: Katchatourian
authors.forename: Aristote
authors.initials: A
authors.lastname: Panos
authors.forename: Marc
authors.initials: M
authors.lastname: Licker
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D003404:Creatinine