Impact of Postarrest Vasoactive-Inotropic Score on Acute Kidney Injury in Cardiac Arrest Survivors: A Retrospective Cohort Study
Background: Postarrest acute kidney injury (AKI) is a major health burden because it is associated with prolonged hospitalization, increased dialysis requirement, high mortality, and unfavorable neurological outcomes. Managing hemodynamic instability during the early postarrest period is critical; h...
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| Format: | Article |
| Language: | English |
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IMR Press
2024-01-01
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| Series: | Reviews in Cardiovascular Medicine |
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| Online Access: | https://www.imrpress.com/journal/RCM/25/1/10.31083/j.rcm2501004 |
| _version_ | 1797338497845035008 |
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| author | Yu-Tzu Tien Wen-Jone Chen Chien-Hua Huang Wei-Ting Chen Hooi-Nee Ong Tao-Ming Huang Wei-Tien Chang Min-Shan Tsai |
| author_facet | Yu-Tzu Tien Wen-Jone Chen Chien-Hua Huang Wei-Ting Chen Hooi-Nee Ong Tao-Ming Huang Wei-Tien Chang Min-Shan Tsai |
| author_sort | Yu-Tzu Tien |
| collection | DOAJ |
| description | Background: Postarrest acute kidney injury (AKI) is a major health burden because it is associated with prolonged hospitalization, increased dialysis requirement, high mortality, and unfavorable neurological outcomes. Managing hemodynamic instability during the early postarrest period is critical; however, the role of quantified vasopressor dependence in AKI development in relation to illness severity remains unclear. Methods: A retrospective, observational cohort study that enrolled 411 non-traumatic adult cardiac arrest survivors without pre-arrest end-stage kidney disease between January 2017 and December 2019, grouped according to their baseline kidney function. The criteria for kidney injury were based on the Kidney Disease: Improving Global Outcomes definition and AKI staging system. The degree of vasopressor dependence within the first 24 h following return of spontaneous circulation (ROSC) was presented using the maximum vasoactive-inotropic score (VISmax). Results: Of the 411 patients, 181 (44%) had early AKI after ROSC. Patients with AKI showed an increased risk of in-hospital mortality (adjusted OR [aOR] 5.40, 95% CI 3.36–8.69, p < 0.001) and unfavorable neurological outcome (aOR 5.70, 95% CI 3.45–9.43, p < 0.001) compared to patients without AKI. The risk of adverse outcomes increased with illness severity. Patients with vasopressor support had an increased risk of early AKI. A low VISmax was associated with AKI stage 1–2 (aOR 2.51, 95% CI 1.20–5.24), whereas a high VISmax was associated with an increased risk for AKI stage 3 (aOR 2.46, 95% CI 1.28–4.75). Conclusions: Early AKI is associated with an increased risk of in-hospital mortality and unfavorable neurologic recovery in cardiac arrest survivors. Postarrest VISmax is an independent predictor of the development and severity of AKI following ROSC, regardless of baseline kidney function. |
| first_indexed | 2024-03-08T09:32:07Z |
| format | Article |
| id | doaj.art-a317772865ab43bebd55add2b9c1e79c |
| institution | Directory Open Access Journal |
| issn | 1530-6550 |
| language | English |
| last_indexed | 2024-03-08T09:32:07Z |
| publishDate | 2024-01-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Reviews in Cardiovascular Medicine |
| spelling | doaj.art-a317772865ab43bebd55add2b9c1e79c2024-01-31T01:12:56ZengIMR PressReviews in Cardiovascular Medicine1530-65502024-01-01251410.31083/j.rcm2501004S1530-6550(23)01136-5Impact of Postarrest Vasoactive-Inotropic Score on Acute Kidney Injury in Cardiac Arrest Survivors: A Retrospective Cohort StudyYu-Tzu Tien0Wen-Jone Chen1Chien-Hua Huang2Wei-Ting Chen3Hooi-Nee Ong4Tao-Ming Huang5Wei-Tien Chang6Min-Shan Tsai7Department of Emergency Medicine, National Taiwan University Medical College and Hospital, 100233 Taipei, TaiwanDepartment of Emergency Medicine, National Taiwan University Medical College and Hospital, 100233 Taipei, TaiwanDepartment of Emergency Medicine, National Taiwan University Medical College and Hospital, 100233 Taipei, TaiwanDepartment of Emergency Medicine, National Taiwan University Medical College and Hospital, 100233 Taipei, TaiwanDepartment of Emergency Medicine, National Taiwan University Medical College and Hospital, 100233 Taipei, TaiwanDepartment of Internal Medicine (Nephrology Division), National Taiwan University Medical College and Hospital, 100233 Taipei, TaiwanDepartment of Emergency Medicine, National Taiwan University Medical College and Hospital, 100233 Taipei, TaiwanDepartment of Emergency Medicine, National Taiwan University Medical College and Hospital, 100233 Taipei, TaiwanBackground: Postarrest acute kidney injury (AKI) is a major health burden because it is associated with prolonged hospitalization, increased dialysis requirement, high mortality, and unfavorable neurological outcomes. Managing hemodynamic instability during the early postarrest period is critical; however, the role of quantified vasopressor dependence in AKI development in relation to illness severity remains unclear. Methods: A retrospective, observational cohort study that enrolled 411 non-traumatic adult cardiac arrest survivors without pre-arrest end-stage kidney disease between January 2017 and December 2019, grouped according to their baseline kidney function. The criteria for kidney injury were based on the Kidney Disease: Improving Global Outcomes definition and AKI staging system. The degree of vasopressor dependence within the first 24 h following return of spontaneous circulation (ROSC) was presented using the maximum vasoactive-inotropic score (VISmax). Results: Of the 411 patients, 181 (44%) had early AKI after ROSC. Patients with AKI showed an increased risk of in-hospital mortality (adjusted OR [aOR] 5.40, 95% CI 3.36–8.69, p < 0.001) and unfavorable neurological outcome (aOR 5.70, 95% CI 3.45–9.43, p < 0.001) compared to patients without AKI. The risk of adverse outcomes increased with illness severity. Patients with vasopressor support had an increased risk of early AKI. A low VISmax was associated with AKI stage 1–2 (aOR 2.51, 95% CI 1.20–5.24), whereas a high VISmax was associated with an increased risk for AKI stage 3 (aOR 2.46, 95% CI 1.28–4.75). Conclusions: Early AKI is associated with an increased risk of in-hospital mortality and unfavorable neurologic recovery in cardiac arrest survivors. Postarrest VISmax is an independent predictor of the development and severity of AKI following ROSC, regardless of baseline kidney function.https://www.imrpress.com/journal/RCM/25/1/10.31083/j.rcm2501004acute kidney injuryaki stagingbaseline kidney functioncardiac arrestvasoactive inotropic score |
| spellingShingle | Yu-Tzu Tien Wen-Jone Chen Chien-Hua Huang Wei-Ting Chen Hooi-Nee Ong Tao-Ming Huang Wei-Tien Chang Min-Shan Tsai Impact of Postarrest Vasoactive-Inotropic Score on Acute Kidney Injury in Cardiac Arrest Survivors: A Retrospective Cohort Study Reviews in Cardiovascular Medicine acute kidney injury aki staging baseline kidney function cardiac arrest vasoactive inotropic score |
| title | Impact of Postarrest Vasoactive-Inotropic Score on Acute Kidney Injury in Cardiac Arrest Survivors: A Retrospective Cohort Study |
| title_full | Impact of Postarrest Vasoactive-Inotropic Score on Acute Kidney Injury in Cardiac Arrest Survivors: A Retrospective Cohort Study |
| title_fullStr | Impact of Postarrest Vasoactive-Inotropic Score on Acute Kidney Injury in Cardiac Arrest Survivors: A Retrospective Cohort Study |
| title_full_unstemmed | Impact of Postarrest Vasoactive-Inotropic Score on Acute Kidney Injury in Cardiac Arrest Survivors: A Retrospective Cohort Study |
| title_short | Impact of Postarrest Vasoactive-Inotropic Score on Acute Kidney Injury in Cardiac Arrest Survivors: A Retrospective Cohort Study |
| title_sort | impact of postarrest vasoactive inotropic score on acute kidney injury in cardiac arrest survivors a retrospective cohort study |
| topic | acute kidney injury aki staging baseline kidney function cardiac arrest vasoactive inotropic score |
| url | https://www.imrpress.com/journal/RCM/25/1/10.31083/j.rcm2501004 |
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