Impact of acute kidney injury on patient outcome in out-of-hospital cardiac arrest: a prospective observational study.
BACKGROUND
Kidney disease after out-of-hospital cardiac arrest (OHCA) is incompletely described. We examined the occurrence of acute kidney injury (AKI) in OHCA patients and impact of AKI, with or without renal replacement therapy (RRT), on 6-month mortality and neurological outcome.


METHODS
Prospective study at Oslo University Hospital, Oslo, Norway. Adult resuscitated comatose OHCA patients treated with targeted temperature management at 33°C for 24 h were included. AKI and chronic kidney disease (CKD) were classified according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Main outcomes were 6-month mortality and good neurological outcome defined as Cerebral Performance Category 1-2.


RESULTS
Among 245 included patients (84% males, mean age 61 years), 11 (4%) had previously known CKD and 112 (46%) developed AKI. Overall 6-month outcome revealed that 112 (46%) died and 123 (50%) had good neurological outcome. Compared with no kidney disease, the presence of AKI was significantly associated with 6-month mortality (odds ratio (OR) 3.17, 95% confidence interval (CI) 1.95-5.43, P < 0.001) and good neurological outcome (OR 0.28, 95% CI 0.16-0.48, P < 0.001). Six-month mortality (50 vs. 61%, P = 0.401) and frequency of good neurological outcome (44 vs. 35%, P = 0.417) were not statistically different in AKI patients with or without RRT, also after excluding patients where RRT was withheld due to futility.


CONCLUSIONS
Kidney disease occurred in about half of patients successfully resuscitated from OHCA. Presence of AKI, but not RRT, was associated with unfavourable 6-month outcome.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.|Department of Anaesthesiology, Oslo University Hospital Ullevål, Oslo, Norway.
S
S
Beitland
Norwegian National unit for CBRNe Medicine, Oslo University Hospital Ullevål, Oslo, Norway.
E R
ER
Nakstad
Department of Anaesthesiology, Oslo University Hospital Ullevål, Oslo, Norway.
H
H
Staer-Jensen
Department of Research and Development, Oslo University Hospital Ullevål, Oslo, Norway.
T
T
Draegni
Depertment of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.
G Ø
GØ
Andersen
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.|Norwegian National unit for CBRNe Medicine, Oslo University Hospital Ullevål, Oslo, Norway.|Department of Acute Medicine, Oslo University Hospital Ullevål, Oslo, Norway.
D
D
Jacobsen
Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
C
C
Brunborg
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.|Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway.
B
B
Waldum-Grevbo
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.|Department of Anaesthesiology, Oslo University Hospital Ullevål, Oslo, Norway.
K
K
Sunde
D058186:Acute Kidney Injury / Q000401:mortality* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality*; D011446:Prospective Studies; D017582:Renal Replacement Therapy