Dataset Information

The Pattern of Longitudinal Change in Serum Creatinine and 90-Day Mortality After Major Surgery.

ABSTRACT: OBJECTIVE:Calculate mortality risk that accounts for both severity and recovery of postoperative kidney dysfunction using the pattern of longitudinal change in creatinine. BACKGROUND:Although the importance of renal recovery after acute kidney injury (AKI) is increasingly recognized, the complex association that accounts for longitudinal creatinine changes and mortality is not fully described. METHODS:We used routinely collected clinical information for 46,299 adult patients undergoing major surgery to develop a multivariable probabilistic model optimized for nonlinearity of serum creatinine time series that calculates the risk function for 90-day mortality. We performed a 70/30 cross validation analysis to assess the accuracy of the model. RESULTS:All creatinine time series exhibited nonlinear risk function in relation to 90-day mortality and their addition to other clinical factors improved the model discrimination. For any given severity of AKI, patients with complete renal recovery, as manifested by the return of the discharge creatinine to the baseline value, experienced a significant decrease in the odds of dying within 90 days of admission compared with patients with partial recovery. Yet, for any severity of AKI, even complete renal recovery did not entirely mitigate the increased odds of dying, as patients with mild AKI and complete renal recovery still had significantly increased odds for dying compared with patients without AKI [odds ratio: 1.48 (95% confidence interval: 1.30-1.68)]. CONCLUSIONS:We demonstrate the nonlinear relationship between both severity and recovery of renal dysfunction and 90-day mortality after major surgery. We have developed an easily applicable computer algorithm that calculates this complex relationship.

SUBMITTER: Korenkevych D

PROVIDER: S-EPMC4829495 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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The Pattern of Longitudinal Change in Serum Creatinine and 90-Day Mortality After Major Surgery.

Korenkevych Dmytro D Ozrazgat-Baslanti Tezcan T Thottakkara Paul P Hobson Charles E CE Pardalos Panos P Momcilovic Petar P Bihorac Azra A

Annals of surgery 20160601 6

<h4>Objective</h4>Calculate mortality risk that accounts for both severity and recovery of postoperative kidney dysfunction using the pattern of longitudinal change in creatinine.<h4>Background</h4>Although the importance of renal recovery after acute kidney injury (AKI) is increasingly recognized, the complex association that accounts for longitudinal creatinine changes and mortality is not fully described.<h4>Methods</h4>We used routinely collected clinical information for 46,299 adult patient ...[more]

PMID: 26181482

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Project description:BackgroundReversing a neuromuscular blockade agent with sugammadex is known to lessen postoperative complications by reducing postoperative residual curarization. However, its effects on 90-day mortality are unknown. Therefore, this study aimed to compare the effects of sugammadex and neostigmine in terms of 90-day mortality after non-cardiac surgery.MethodsThis retrospective cohort study analyzed the medical records of adult patients aged 18 years or older who underwent non-cardiac surgery at a single tertiary care hospital between 2011 and 2016. Propensity score matching and Cox regression analysis were used to investigate the effectiveness of sugammadex and neostigmine in lowering 90-day mortality after non-cardiac surgery.ResultsA total of 65,702 patients were included in the analysis (mean age: 52.3 years, standard deviation: 15.7), and 23,532 of these patients (35.8%) received general surgery. After propensity score matching, 14,179 patients (3906 patients from the sugammadex group and 10,273 patients from the neostigmine group) were included in the final analysis. Cox regression analysis in the propensity score-matched cohort showed that the risk of 90-day mortality was 40% lower in the sugammadex group than in the neostigmine group (hazard ratio: 0.60, 95% confidence interval: 0.37, 0.98; P = 0.042). These results were similar in the multivariable Cox regression analysis of the entire cohort (hazard ratio: 0.62, 95% confidence interval: 0.39, 0.96; P = 0.036).ConclusionsThis retrospective cohort study suggested that reversing rocuronium with sugammadex might be associated with lower 90-day mortality after non-cardiac surgery compared to neostigmine. However, since this study did not evaluate quantitative neuromuscular function in the postoperative period due to its retrospective design, the results should be interpreted carefully. Future prospective studies with quantitative neuromuscular monitoring in the postoperative period should be performed to confirm these results.

Dataset Information

The Pattern of Longitudinal Change in Serum Creatinine and 90-Day Mortality After Major Surgery.

Publications

The Pattern of Longitudinal Change in Serum Creatinine and 90-Day Mortality After Major Surgery.

Similar Datasets

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