title: Use of postoperative creatinine to predict sustained kidney injury in patients undergoing mesothelioma surgery.
abstract: OBJECTIVE
  AKI leads to increased morbidity and mortality and progression to chronic kidney injury is a frequent consequence of AKI. Surgical treatment of mesothelioma is associated with increased risk for kidney injury. However, sustained kidney injury may limit therapeutic options for treating residual cancer. This study hypothesized that patients with significant serum creatinine (sCr) elevation within 48 hours of surgery would be at risk for sustained kidney injury. The goal was to determine the best acute sCr measure predictive of sustained kidney injury defined as a 50% increase in sCr from baseline measured 2-4 weeks after surgery.
  
  
  METHODS
  In a prospective, observational cohort of surgical patients with mesothelioma, receiver operator characteristic curves were generated for the 24- and 48-hour absolute difference and relative sCr change over baseline in the derivation cohort (n=279). The prediction was tested in a validation cohort (n=207). The ability of various other AKI definitions to predict sustained kidney injury was evaluated.
  
  
  RESULTS
  Sustained kidney injury occurred in 9.8% of patients in the derivation cohort. A ≥59% increase in sCr 48 hours after surgery was most predictive of sustained kidney injury (c statistic=0.78). Among other AKI definitions, a sCr increase of 0.3 mg/dl in 24 hours or 0.5 mg/dl increase in 48 hours (Waikar and Bonventre criteria) also reliably predicted sustained kidney injury.
  
  
  CONCLUSIONS
  Development of clinically significant sustained kidney injury can be predicted by acute postoperative sCr elevation in patients treated for mesothelioma.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. amizuguchi@partners.org
authors.forename: K Annette
authors.initials: KA
authors.lastname: Mizuguchi
authors.forename: Aya
authors.initials: A
authors.lastname: Mitani
authors.forename: Sushrut S
authors.initials: SS
authors.lastname: Waikar
authors.forename: Peter
authors.initials: P
authors.lastname: Ireland
authors.forename: Christia
authors.initials: C
authors.lastname: Panizales
authors.forename: Gretchen
authors.initials: G
authors.lastname: Deluke
authors.forename: David J
authors.initials: DJ
authors.lastname: Sugarbaker
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Bonventre
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Frendl
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000175:diagnosis*; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000601:surgery*; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011446:Prospective Studies
chemical_list: D003404:Creatinine