Association between acute kidney injury and norepinephrine use following cardiac surgery : a retrospective propensity score-weighted analysis
© 2022. The Author(s)..
BACKGROUND: Excess exposure to norepinephrine can compromise microcirculation and organ function. We aimed to assess the association between norepinephrine exposure and acute kidney injury (AKI) and intensive care unit (ICU) mortality after cardiac surgery.
METHODS: This retrospective observational study included adult patients who underwent cardiac surgery under cardiopulmonary bypass from January 1, 2008, to December 31, 2017, at the Amiens University Hospital in France. The primary exposure variable was postoperative norepinephrine during the ICU stay and the primary endpoint was the presence of AKI. The secondary endpoint was in-ICU mortality. As the cohort was nonrandom, inverse probability weighting (IPW) derived from propensity scores was used to reduce imbalances in the pre- and intra-operative characteristics.
RESULTS: Among a population of 5053 patients, 1605 (32%) were exposed to norepinephrine following cardiac surgery. Before weighting, the prevalence of AKI was 25% and ICU mortality 10% for patients exposed to norepinephrine. Exposure to norepinephrine was estimated to be significantly associated with AKI by a factor of 1.95 (95% confidence interval, 1.63-2.34%; P < 0.001) in the IPW cohort and with in-ICU mortality by a factor of 1.54 (95% confidence interval, 1.19-1.99%; P < 0.001).
CONCLUSION: Norepinephrine was associated with AKI and in-ICU mortality following cardiac surgery. While these results discourage norepinephrine use for vasoplegic syndrome in cardiac surgery, prospective investigations are needed to substantiate findings and to suggest alternative strategies for organ protection.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
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| Enthalten in: |
Annals of intensive care - 12(2022), 1 vom: 04. Juli, Seite 61 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Huette, Pierre [VerfasserIn] |
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| Links: |
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| Themen: |
Acute kidney injury |
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| Anmerkungen: |
Date Revised 30.08.2022 published: Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1186/s13613-022-01037-1 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM343023148 |
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| 100 | 1 | |a Huette, Pierre |e verfasserin |4 aut | |
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| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2022. The Author(s). | ||
| 520 | |a BACKGROUND: Excess exposure to norepinephrine can compromise microcirculation and organ function. We aimed to assess the association between norepinephrine exposure and acute kidney injury (AKI) and intensive care unit (ICU) mortality after cardiac surgery | ||
| 520 | |a METHODS: This retrospective observational study included adult patients who underwent cardiac surgery under cardiopulmonary bypass from January 1, 2008, to December 31, 2017, at the Amiens University Hospital in France. The primary exposure variable was postoperative norepinephrine during the ICU stay and the primary endpoint was the presence of AKI. The secondary endpoint was in-ICU mortality. As the cohort was nonrandom, inverse probability weighting (IPW) derived from propensity scores was used to reduce imbalances in the pre- and intra-operative characteristics | ||
| 520 | |a RESULTS: Among a population of 5053 patients, 1605 (32%) were exposed to norepinephrine following cardiac surgery. Before weighting, the prevalence of AKI was 25% and ICU mortality 10% for patients exposed to norepinephrine. Exposure to norepinephrine was estimated to be significantly associated with AKI by a factor of 1.95 (95% confidence interval, 1.63-2.34%; P < 0.001) in the IPW cohort and with in-ICU mortality by a factor of 1.54 (95% confidence interval, 1.19-1.99%; P < 0.001) | ||
| 520 | |a CONCLUSION: Norepinephrine was associated with AKI and in-ICU mortality following cardiac surgery. While these results discourage norepinephrine use for vasoplegic syndrome in cardiac surgery, prospective investigations are needed to substantiate findings and to suggest alternative strategies for organ protection | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute kidney injury | |
| 650 | 4 | |a Cardiac surgery | |
| 650 | 4 | |a Mortality | |
| 650 | 4 | |a Norepinephrine | |
| 650 | 4 | |a Propensity analysis | |
| 700 | 1 | |a Moussa, Mouhamed Djahoum |e verfasserin |4 aut | |
| 700 | 1 | |a Beyls, Christophe |e verfasserin |4 aut | |
| 700 | 1 | |a Guinot, Pierre-Grégoire |e verfasserin |4 aut | |
| 700 | 1 | |a Guilbart, Mathieu |e verfasserin |4 aut | |
| 700 | 1 | |a Besserve, Patricia |e verfasserin |4 aut | |
| 700 | 1 | |a Bouhlal, Mehdi |e verfasserin |4 aut | |
| 700 | 1 | |a Mounjid, Sarah |e verfasserin |4 aut | |
| 700 | 1 | |a Dupont, Hervé |e verfasserin |4 aut | |
| 700 | 1 | |a Mahjoub, Yazine |e verfasserin |4 aut | |
| 700 | 1 | |a Michaud, Audrey |e verfasserin |4 aut | |
| 700 | 1 | |a Abou-Arab, Osama |e verfasserin |4 aut | |
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