Risk factors, outcomes, and early prediction of cardiac surgery-associated acute kidney injury: a post hoc subgroup analysis of the Epidemiology of Surgery Associated Acute Kidney Injury study
Author Department
Surgery
Document Type
Article, Peer-reviewed
Publication Date
10-2025
Abstract
Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common and important complication. The risk factors for CSA-AKI remain poorly described. We aimed to identify risk factors for CSA-AKI and develop a risk score for persistent CSA-AKI.
Methods: We performed a post hoc subgroup analysis restricted to patients who underwent cardiac surgery within the Epidemiology of Surgery Associated Acute Kidney Injury (EPIS-AKI) study. CSA-AKI was defined as AKI (according to the Kidney Disease: Improving Global Outcomes criteria) within 72 h after surgery. Persistent CSA-AKI was defined as CSA-AKI lasting >48 h. We performed multivariable logistic regression analyses to identify risk factors for CSA-AKI and related outcomes.
Results: The original EPIS-AKI study included 3101 cardiac surgery patients. Of these, 802 (25.9%) developed CSA-AKI. On follow-up, 279 of the 802 patients (34.8%) developed persistent CSA-AKI. We identified independent risk factors for CSA-AKI, moderate/severe CSA-AKI, and persistent CSA-AKI. Patients with persistent CSA-AKI had a higher ICU and hospital mortality compared with patients with transient CSA-AKI. We developed a risk score for predicting persistent CSA-AKI with an area under the receiver operating characteristic curve of 0.79 (95% confidence interval, 0.7355-0.8457).
Conclusions: Overall, 25% of cardiac surgery patients developed CSA-AKI, and 33% of these patients experienced persistent CSA-AKI, which was associated with poor outcomes. We developed a risk score for predicting persistent CSA-AKI, the 'EPIS CSA-AKI risk score'. Pending further external validation, the score might be used to identify patients who have a high risk for developing persistent CSA-AKI.
Keywords: acute kidney injury; cardiac surgery; cardiac surgery-associated acute kidney injury; persistent acute kidney injury; renal failure.
Recommended Citation
Strauß C, Albert F, Bormann E, Engelman DT, Bellomo R, Zarbock A; EPIS-AKI investigators. Risk factors, outcomes, and early prediction of cardiac surgery-associated acute kidney injury: a post hoc subgroup analysis of the Epidemiology of Surgery Associated Acute Kidney Injury study. Br J Anaesth. 2025 Oct 8:S0007-0912(25)00612-9. doi: 10.1016/j.bja.2025.08.043. Epub ahead of print.
PMID
41068032