Supplementum 276: Abstracts of the 8th Annual Spring Congress of the Swiss Society of General Internal Medicine (Basel, Switzerland, May 29−31, 2024)

Abstract

Aim:The importance of acute kidney injury (AKI) after major non-cardiac surgery is incompletely understood.The aim of this study was to evaluate the association of AKI with short-term complications (e.g.perioperative myocardial injury (PMI); acute heart failure (AHF)), and long-term adverse outcomes (e.g.readmission for AHF, all-cause mortality). Methods:The prospective observational international multicenter BASEL PMI study (ClinicalTrials NCT02573532) screened inpatients aged 40-85 at high cardiovascular risk undergoing non-cardiac surgery at tertiary hospitals to detect asymptomatic PMI.This secondary analysis focused on AKI, with prospective adjudication of AKI, PMI and AHF by blinded experts. Results:In 11'133 patient cases, the incidence of AKI within 7 days was 11.1%, classified as stage one (68.3%),two (15.4%) and three (16.3%).Pre-and perioperative determinants for AKI were male sex (OR 1.29), chronic heart failure (CHF, OR 1.45), the need for intraoperative blood transfusion (OR 1.56), preoperative GFR (OR 1.02) and surgery duration (OR 1.01).Median time to occurrence of AKI was 2 days (IQR 1-4), in contrast to PMI (median 1, IQR 1-2) and AHF (median 5, IQR 2-9).41% of all AKI patients experienced additionally a PMI.In multivariable Cox regression analysis, AKI (aHR 1.76, 95% CI 1.51-2.06)and PMI (aHR 1.21, 95% CI 1.02-1.45)were both independently associated with prediction of one-year all-cause mortality after adjustment for each other and confounding factors.The coincidence of AKI and PMI resulted in an additive effect on overall mortality.Importantly, patients with AKI showed more in-hospital AHF (aHR 2.08, 95% CI 1.49-2.91)within 30 days and higher readmission rates for AHF within one year (aHR 1.42, 95% CI 1.02-1.98)than patients without AKI, even patients without known heart failure (aHR 1.77, 95% CI 1.13-2.78). Conclusion:AKI is a common complication, occuring in 11% after non-cardiac surgery.The high coincidence of AKI with PMI suggests common pathophysiological triggers.The occurrence of AKI was associated with increased risks for in-hospital AHF, AHF readmissions and all-cause mortality.Even AKI patients without previously known heart failure faced AHF rehospitalization.The occurrence of AKI unveiling previously unknown heart failure highlights the importance of systematic monitoring for AKI after surgery.

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