Preoperative Serum Creatinine Changes and Acute Kidney Injury in Patients Underwent Cardiac Surgery

Bo Jiang¹Yi Hao¹Meiping Wang²Liyan Chen^1,3Zhenhua Zhang¹Ning He¹Yueling Chen¹Shuai Zhu¹Haiping Yang^1*Li Jiang^2*

• ¹Beijing Luhe Hospital, Capital Medical University, Beijing, Beijing Municipality, China
• ²Xuanwu Hospital, Capital Medical University, Beijing, China
• ³Beijing Water Conservancy and Hydropower School, Beijing, China

Introduction Preoperative serum creatinine fluctuations are common in open-heart surgery, and their association with postoperative acute kidney injury (AKI) and the combined impact on patient outcomes warrant further investigation. Methods This retrospective cohort study assessed patients undergoing open-heart surgery. Preoperative serum creatinine changes (ΔScr) were calculated as the difference between the serum creatinine value within 48 hours before surgery and baseline. Patients were categorized into three groups based on ΔScr: negative (< 0 mg/dL), normal (0–0.3 mg/dL), and elevated (≥ 0.3 mg/dL). Multivariable logistic regression and restricted cubic spline models were used to analyze the clinical outcomes. Results Of the 560 patients included, 40.2% developed AKI. There were significant increases in the odds of AKI (adjusted odds ratio [AOR], 1.51; 95% CI, 1.32‒1.72, per 0.1 mg/dL increase), severe AKI (AOR, 1.45; 95% CI, 1.24–1.70), and AKI non-recovery (AOR, 1.37; 95% CI, 1.19‒1.59). In AKI patients, negative ΔScr was associated with a higher rate of in-hospital mortality and ICU LOS >72 hours compared to without AKI, while elevated ΔScr showed no significant differences. In addition, negative ΔScr was associated with a higher risk of in-hospital mortality (AOR, 4.50; 95% CI, 1.00–20.15) and ICU LOS >72 hours (AOR, 2.81; 95% CI, 1.13‒6.96) compared with normal ΔScr. No significant associations were observed with elevated ΔScr. In contrast, among patients without AKI, neither negative nor elevated ΔScr were associated with in-hospital mortality or prolonged ICU LOS. Conclusions In this retrospective study of elective cardiac surgery, negative changes in preoperative serum creatinine were less likely to development of AKI. However, patients with negative changes who developed postoperative AKI had a higher risk of in-hospital mortality and prolonged ICU stays. No significant associations with these outcomes were observed with elevated changes.