PURPOSE: To describe the incidence of acute renal injury (ARI) and assess risk factors for ARI for patients requiring surgical intervention for peripheral vascular disease (PVD) Intensive Care Unit (ICU) admission.
METHODS: We identified patients with PVD admitted postoperatively to a 20-bed vascular surgical ICU. We retrieved the following data from the electronic medical records: demographics, severity of illness as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) III prognostic model, baseline and worst creatinine level. In patients with ARI we assessed fluid balance on the day of surgery and the duration of surgery and anesthesia. We calculated odds ratio (OR) and 95% confidence interval (CI) when appropriate. P values less than 0.05 were considered significant.
RESULTS: 125 patients were included in the study. Patients’ mean (SD) age was 67.5(15.5) years and 53(42%) were female. Sixteen patients (13%) had femoro-femoral bypass, 21 (17%) had femoro-popliteal bypass, 26 (21%) had surgical thrombectomy, and 60 patients (49%) had other peripheral vascular graft surgeries. Patients with ARI had fluid balance of 4.4 liters (3.1–6.4) on the operative day. Median (IQR) anesthesia and surgery durations were 6(5–8) and 5.5(3.6–7) hours respectively.Eleven patients (9%) developed ARI. Seven patients (64%) their creatinine raised by 1.5 to 2 times the baseline. Three (27%) had transient loss of their renal function. One (9%) developed ESRD. Higher APACHE III score was a risk for ARI. Age, gender, and baseline creatinine did not increase the risk for ARI. The APACHE III predicted mortality rate was 3.0% and the observed 28-mortality rate was 7%. Logistic regression including ARI and APACHE III predicted mortality rate showed that ARI is not independently associated with 28-day mortality, OR with 95% CI 3.37 (2.72 –28.9) (P = 0.165).
CONCLUSION: ARI is common in patients with peripheral vascular surgery admitted to the ICU. Higher APACHE III score is a risk for developing ARI. ARI does not independently increase 28-day mortality.
CLINICAL IMPLICATIONS: In ICU; ARI is a common complication of PVD surgeries.
DISCLOSURE: Salam Salman, No Financial Disclosure Information; No Product/Research Disclosure Information