title: Acute Kidney Injury After Cardiac Surgery by Complete KDIGO Criteria Predicts Increased Mortality.
abstract: OBJECTIVE
  Acute kidney injury (AKI) occurs frequently after cardiac surgery and is associated with increased mortality. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria for diagnosing AKI include creatinine and urine output values. However, the value of the latter is debated. The authors aimed to evaluate the incidence of AKI after cardiac surgery and the independent association of KDIGO criteria, especially the urine output criterion, and 2.5-year mortality.
  
  
  METHODS
  Prospective, observational, cohort study.
  
  
  METHODS
  Single-center study in a university hospital.
  
  
  METHODS
  The study comprised 638 cardiac surgical patients from September 1, 2011, to June 20, 2012.
  
  
  METHODS
  None.
  
  
  RESULTS
  Hourly urine output, daily plasma creatinine, risk factors for AKI, and variables for EuroSCORE II were recorded. AKI occurred in 183 (28.7%) patients. Patients with AKI diagnosed using only urine output had higher 2.5-year mortality than did patients without AKI (9/53 [17.0%] v 23/455 [5.1%], p = 0.001). AKI was associated with mortality (hazard ratios [95% confidence intervals]: 3.3 [1.8-6.1] for KDIGO 1; 5.8 [2.7-12.1] for KDIGO 2; and 7.9 [3.5-17.6]) for KDIGO 3. KDIGO stages and AKI diagnosed using urine output were associated with mortality even after adjusting for mortality risk assessed using EuroSCORE II and risk factors for AKI.
  
  
  CONCLUSIONS
  AKI diagnosed using only the urine output criterion without fulfilling the creatinine criterion and all stages of AKI were associated with long-term mortality. Preoperatively assessed mortality risk using EuroSCORE II did not predict this AKI-associated mortality.
authors.affiliation: Division of Anesthesiology, Helsinki University and Helsinki University Hospital, Helsinki, Finland. Electronic address: liisa.petaja@hus.fi.
authors.forename: Liisa
authors.initials: L
authors.lastname: Petäjä
authors.affiliation: Division of Intensive Care, Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Suvi
authors.initials: S
authors.lastname: Vaara
authors.affiliation: Division of Anesthesiology, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Sasu
authors.initials: S
authors.lastname: Liuhanen
authors.affiliation: Division of Anesthesiology, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Raili
authors.initials: R
authors.lastname: Suojaranta-Ylinen
authors.affiliation: Division of Anesthesiology, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Leena
authors.initials: L
authors.lastname: Mildh
authors.affiliation: Division of Intensive Care, Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Sara
authors.initials: S
authors.lastname: Nisula
authors.affiliation: Division of Intensive Care, Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Anna-Maija
authors.initials: AM
authors.lastname: Korhonen
authors.affiliation: Division of Intensive Care, Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Kirsi-Maija
authors.initials: KM
authors.lastname: Kaukonen
authors.affiliation: Division of Anesthesiology, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Salmenperä
authors.affiliation: Division of Anesthesiology, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality* / Q000652:urine; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality* / Q000639:trends; D015331:Cohort Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality* / Q000652:urine; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: EuroSCORE II; acute kidney injury; cardiac surgery; mortality