Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery

Roland Tóth, Tamás Breuer, Zsuzsanna Cserép, Dániel Lex, Levente Fazekas, Erzsébet Sápi, A. Szatmári, J. Gál, Andrea Székely

Research output: Article

62 Citations (Scopus)

Abstract

Background: The RIFLE (risk, injury, failure, loss, and end-stage renal disease) classification system was developed to standardize the definition of acute kidney injury (AKI) in adults. We hypothesized that AKI was associated with increased mortality and morbidity. Methods: Acute kidney injury was defined as a decrease in the amount of estimated creatinine clearance based on pediatric-modified RIFLE (pRIFLE) criteria. Using propensity score analysis, 325 patients who had AKI were matched to 325 patients who did not have AKI from a database of 1,510 consecutive pediatric patients who underwent cardiac surgery between January 2004 and December 2008 at a single center. The association between AKI and outcome was analyzed after propensity score matching of perioperative variables. Results: Four hundred eighty-one patients (31.9%) had AKI according to the RIFLE categories. Of those 1,510, 173 (11.5%) reached pRIFLE criteria for risk; 26 (1.7%) reached the criteria for injury; and 282 (18.7%) reached the criteria for failure. Fifty-five patients (3.6%) died. The 2 matched groups were well balanced in terms of measured perioperative variables. Mortality rate was 5.2% in the AKI and 2.5% in the matched control group (p = 0.09). Occurrence of low cardiac output syndrome (p = 0.002), need for dialysis (p <0.001), and infection (p = 0.03) were significantly higher, and duration of mechanical ventilation (p <0.001) and length of intensive care unit stay (p <0.001) were significantly longer compared with the matched control group. Conclusions: Acute kidney injury was independently associated with an increased occurrence of postoperative complications but not with mortality after pediatric cardiac surgery.

Original languageEnglish
Pages (from-to)1984-1991
Number of pages8
JournalAnnals of Thoracic Surgery
Volume93
Issue number6
DOIs
Publication statusPublished - jún. 2012

Fingerprint

Acute Kidney Injury
Thoracic Surgery
Pediatrics
Morbidity
Propensity Score
Research Design
Mortality
Low Cardiac Output
Control Groups
Wounds and Injuries
Artificial Respiration
Chronic Kidney Failure
Intensive Care Units
Dialysis
Creatinine
Databases
Infection

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery. / Tóth, Roland; Breuer, Tamás; Cserép, Zsuzsanna; Lex, Dániel; Fazekas, Levente; Sápi, Erzsébet; Szatmári, A.; Gál, J.; Székely, Andrea.

In: Annals of Thoracic Surgery, Vol. 93, No. 6, 06.2012, p. 1984-1991.

Research output: Article

Tóth, Roland ; Breuer, Tamás ; Cserép, Zsuzsanna ; Lex, Dániel ; Fazekas, Levente ; Sápi, Erzsébet ; Szatmári, A. ; Gál, J. ; Székely, Andrea. / Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery. In: Annals of Thoracic Surgery. 2012 ; Vol. 93, No. 6. pp. 1984-1991.
@article{da98f8d9f44c4b279e984350f079c03d,
title = "Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery",
abstract = "Background: The RIFLE (risk, injury, failure, loss, and end-stage renal disease) classification system was developed to standardize the definition of acute kidney injury (AKI) in adults. We hypothesized that AKI was associated with increased mortality and morbidity. Methods: Acute kidney injury was defined as a decrease in the amount of estimated creatinine clearance based on pediatric-modified RIFLE (pRIFLE) criteria. Using propensity score analysis, 325 patients who had AKI were matched to 325 patients who did not have AKI from a database of 1,510 consecutive pediatric patients who underwent cardiac surgery between January 2004 and December 2008 at a single center. The association between AKI and outcome was analyzed after propensity score matching of perioperative variables. Results: Four hundred eighty-one patients (31.9{\%}) had AKI according to the RIFLE categories. Of those 1,510, 173 (11.5{\%}) reached pRIFLE criteria for risk; 26 (1.7{\%}) reached the criteria for injury; and 282 (18.7{\%}) reached the criteria for failure. Fifty-five patients (3.6{\%}) died. The 2 matched groups were well balanced in terms of measured perioperative variables. Mortality rate was 5.2{\%} in the AKI and 2.5{\%} in the matched control group (p = 0.09). Occurrence of low cardiac output syndrome (p = 0.002), need for dialysis (p <0.001), and infection (p = 0.03) were significantly higher, and duration of mechanical ventilation (p <0.001) and length of intensive care unit stay (p <0.001) were significantly longer compared with the matched control group. Conclusions: Acute kidney injury was independently associated with an increased occurrence of postoperative complications but not with mortality after pediatric cardiac surgery.",
author = "Roland T{\'o}th and Tam{\'a}s Breuer and Zsuzsanna Cser{\'e}p and D{\'a}niel Lex and Levente Fazekas and Erzs{\'e}bet S{\'a}pi and A. Szatm{\'a}ri and J. G{\'a}l and Andrea Sz{\'e}kely",
year = "2012",
month = "6",
doi = "10.1016/j.athoracsur.2011.10.046",
language = "English",
volume = "93",
pages = "1984--1991",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "6",

}

TY - JOUR

T1 - Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery

AU - Tóth, Roland

AU - Breuer, Tamás

AU - Cserép, Zsuzsanna

AU - Lex, Dániel

AU - Fazekas, Levente

AU - Sápi, Erzsébet

AU - Szatmári, A.

AU - Gál, J.

AU - Székely, Andrea

PY - 2012/6

Y1 - 2012/6

N2 - Background: The RIFLE (risk, injury, failure, loss, and end-stage renal disease) classification system was developed to standardize the definition of acute kidney injury (AKI) in adults. We hypothesized that AKI was associated with increased mortality and morbidity. Methods: Acute kidney injury was defined as a decrease in the amount of estimated creatinine clearance based on pediatric-modified RIFLE (pRIFLE) criteria. Using propensity score analysis, 325 patients who had AKI were matched to 325 patients who did not have AKI from a database of 1,510 consecutive pediatric patients who underwent cardiac surgery between January 2004 and December 2008 at a single center. The association between AKI and outcome was analyzed after propensity score matching of perioperative variables. Results: Four hundred eighty-one patients (31.9%) had AKI according to the RIFLE categories. Of those 1,510, 173 (11.5%) reached pRIFLE criteria for risk; 26 (1.7%) reached the criteria for injury; and 282 (18.7%) reached the criteria for failure. Fifty-five patients (3.6%) died. The 2 matched groups were well balanced in terms of measured perioperative variables. Mortality rate was 5.2% in the AKI and 2.5% in the matched control group (p = 0.09). Occurrence of low cardiac output syndrome (p = 0.002), need for dialysis (p <0.001), and infection (p = 0.03) were significantly higher, and duration of mechanical ventilation (p <0.001) and length of intensive care unit stay (p <0.001) were significantly longer compared with the matched control group. Conclusions: Acute kidney injury was independently associated with an increased occurrence of postoperative complications but not with mortality after pediatric cardiac surgery.

AB - Background: The RIFLE (risk, injury, failure, loss, and end-stage renal disease) classification system was developed to standardize the definition of acute kidney injury (AKI) in adults. We hypothesized that AKI was associated with increased mortality and morbidity. Methods: Acute kidney injury was defined as a decrease in the amount of estimated creatinine clearance based on pediatric-modified RIFLE (pRIFLE) criteria. Using propensity score analysis, 325 patients who had AKI were matched to 325 patients who did not have AKI from a database of 1,510 consecutive pediatric patients who underwent cardiac surgery between January 2004 and December 2008 at a single center. The association between AKI and outcome was analyzed after propensity score matching of perioperative variables. Results: Four hundred eighty-one patients (31.9%) had AKI according to the RIFLE categories. Of those 1,510, 173 (11.5%) reached pRIFLE criteria for risk; 26 (1.7%) reached the criteria for injury; and 282 (18.7%) reached the criteria for failure. Fifty-five patients (3.6%) died. The 2 matched groups were well balanced in terms of measured perioperative variables. Mortality rate was 5.2% in the AKI and 2.5% in the matched control group (p = 0.09). Occurrence of low cardiac output syndrome (p = 0.002), need for dialysis (p <0.001), and infection (p = 0.03) were significantly higher, and duration of mechanical ventilation (p <0.001) and length of intensive care unit stay (p <0.001) were significantly longer compared with the matched control group. Conclusions: Acute kidney injury was independently associated with an increased occurrence of postoperative complications but not with mortality after pediatric cardiac surgery.

UR - http://www.scopus.com/inward/record.url?scp=84861596774&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861596774&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2011.10.046

DO - 10.1016/j.athoracsur.2011.10.046

M3 - Article

C2 - 22226235

AN - SCOPUS:84861596774

VL - 93

SP - 1984

EP - 1991

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 6

ER -