Inflammation as a predictor of acute kidney injury and mediator of higher mortality after acute kidney injury in non-cardiac surgery

This retrospective cohort study examined the roles of inflammation in acute kidney injury (AKI). Serum albumin and C-reactive protein (CRP) were used as markers of inflammation. Adults who underwent non–cardiac surgery from 2007 to 2011 were included. Exclusion criteria were urological surgery, obst...

Descripción completa

Detalles Bibliográficos
Autores principales: Murashima, Miho, Nishimoto, Masatoshi, Kokubu, Maiko, Hamano, Takayuki, Matsui, Masaru, Eriguchi, Masahiro, Samejima, Ken-ichi, Akai, Yasuhiro, Tsuruya, Kazuhiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937243/
https://www.ncbi.nlm.nih.gov/pubmed/31889082
http://dx.doi.org/10.1038/s41598-019-56615-4
_version_ 1783483840208044032
author Murashima, Miho
Nishimoto, Masatoshi
Kokubu, Maiko
Hamano, Takayuki
Matsui, Masaru
Eriguchi, Masahiro
Samejima, Ken-ichi
Akai, Yasuhiro
Tsuruya, Kazuhiko
author_facet Murashima, Miho
Nishimoto, Masatoshi
Kokubu, Maiko
Hamano, Takayuki
Matsui, Masaru
Eriguchi, Masahiro
Samejima, Ken-ichi
Akai, Yasuhiro
Tsuruya, Kazuhiko
author_sort Murashima, Miho
collection PubMed
description This retrospective cohort study examined the roles of inflammation in acute kidney injury (AKI). Serum albumin and C-reactive protein (CRP) were used as markers of inflammation. Adults who underwent non–cardiac surgery from 2007 to 2011 were included. Exclusion criteria were urological surgery, obstetric surgery, missing data, and pre-operative dialysis. Subjects were followed until the end of 2015 or loss to follow-up. Associations between pre–operative albumin or CRP and post-operative AKI or association between AKI and mortality were examined by logistic or Cox regression, respectively. Mediation analyses were performed using albumin and CRP as mediators. Among 4,538 subjects, 272 developed AKI. Pre-operative albumin was independently associated with AKI (odds ratio [95% confidence interval (CI)]: 0.63 [0.48–0.83]). During a median follow-up of 4.5 years, 649 died. AKI was significantly associated with mortality (hazard ratio [HR] [95% CI]: 1.58 [1.22–2.04]). Further adjustment for pre-operative albumin and CRP attenuated the association (HR [95% CI]: 1.28 [0.99–1.67]). The proportions explained by mediating effects of lnCRP and albumin were 29.3% and 39.2% and mediation effects were statistically significant. In conclusion, inflammation is a predictor of AKI and a mediator of mortality after AKI. Interventions targeting inflammation might improve outcomes of AKI.
format Online
Article
Text
id pubmed-6937243
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Nature Publishing Group UK
record_format MEDLINE/PubMed
spelling pubmed-69372432020-01-06 Inflammation as a predictor of acute kidney injury and mediator of higher mortality after acute kidney injury in non-cardiac surgery Murashima, Miho Nishimoto, Masatoshi Kokubu, Maiko Hamano, Takayuki Matsui, Masaru Eriguchi, Masahiro Samejima, Ken-ichi Akai, Yasuhiro Tsuruya, Kazuhiko Sci Rep Article This retrospective cohort study examined the roles of inflammation in acute kidney injury (AKI). Serum albumin and C-reactive protein (CRP) were used as markers of inflammation. Adults who underwent non–cardiac surgery from 2007 to 2011 were included. Exclusion criteria were urological surgery, obstetric surgery, missing data, and pre-operative dialysis. Subjects were followed until the end of 2015 or loss to follow-up. Associations between pre–operative albumin or CRP and post-operative AKI or association between AKI and mortality were examined by logistic or Cox regression, respectively. Mediation analyses were performed using albumin and CRP as mediators. Among 4,538 subjects, 272 developed AKI. Pre-operative albumin was independently associated with AKI (odds ratio [95% confidence interval (CI)]: 0.63 [0.48–0.83]). During a median follow-up of 4.5 years, 649 died. AKI was significantly associated with mortality (hazard ratio [HR] [95% CI]: 1.58 [1.22–2.04]). Further adjustment for pre-operative albumin and CRP attenuated the association (HR [95% CI]: 1.28 [0.99–1.67]). The proportions explained by mediating effects of lnCRP and albumin were 29.3% and 39.2% and mediation effects were statistically significant. In conclusion, inflammation is a predictor of AKI and a mediator of mortality after AKI. Interventions targeting inflammation might improve outcomes of AKI. Nature Publishing Group UK 2019-12-30 /pmc/articles/PMC6937243/ /pubmed/31889082 http://dx.doi.org/10.1038/s41598-019-56615-4 Text en © The Author(s) 2019 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
Murashima, Miho
Nishimoto, Masatoshi
Kokubu, Maiko
Hamano, Takayuki
Matsui, Masaru
Eriguchi, Masahiro
Samejima, Ken-ichi
Akai, Yasuhiro
Tsuruya, Kazuhiko
Inflammation as a predictor of acute kidney injury and mediator of higher mortality after acute kidney injury in non-cardiac surgery
title Inflammation as a predictor of acute kidney injury and mediator of higher mortality after acute kidney injury in non-cardiac surgery
title_full Inflammation as a predictor of acute kidney injury and mediator of higher mortality after acute kidney injury in non-cardiac surgery
title_fullStr Inflammation as a predictor of acute kidney injury and mediator of higher mortality after acute kidney injury in non-cardiac surgery
title_full_unstemmed Inflammation as a predictor of acute kidney injury and mediator of higher mortality after acute kidney injury in non-cardiac surgery
title_short Inflammation as a predictor of acute kidney injury and mediator of higher mortality after acute kidney injury in non-cardiac surgery
title_sort inflammation as a predictor of acute kidney injury and mediator of higher mortality after acute kidney injury in non-cardiac surgery
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937243/
https://www.ncbi.nlm.nih.gov/pubmed/31889082
http://dx.doi.org/10.1038/s41598-019-56615-4
work_keys_str_mv AT murashimamiho inflammationasapredictorofacutekidneyinjuryandmediatorofhighermortalityafteracutekidneyinjuryinnoncardiacsurgery
AT nishimotomasatoshi inflammationasapredictorofacutekidneyinjuryandmediatorofhighermortalityafteracutekidneyinjuryinnoncardiacsurgery
AT kokubumaiko inflammationasapredictorofacutekidneyinjuryandmediatorofhighermortalityafteracutekidneyinjuryinnoncardiacsurgery
AT hamanotakayuki inflammationasapredictorofacutekidneyinjuryandmediatorofhighermortalityafteracutekidneyinjuryinnoncardiacsurgery
AT matsuimasaru inflammationasapredictorofacutekidneyinjuryandmediatorofhighermortalityafteracutekidneyinjuryinnoncardiacsurgery
AT eriguchimasahiro inflammationasapredictorofacutekidneyinjuryandmediatorofhighermortalityafteracutekidneyinjuryinnoncardiacsurgery
AT samejimakenichi inflammationasapredictorofacutekidneyinjuryandmediatorofhighermortalityafteracutekidneyinjuryinnoncardiacsurgery
AT akaiyasuhiro inflammationasapredictorofacutekidneyinjuryandmediatorofhighermortalityafteracutekidneyinjuryinnoncardiacsurgery
AT tsuruyakazuhiko inflammationasapredictorofacutekidneyinjuryandmediatorofhighermortalityafteracutekidneyinjuryinnoncardiacsurgery