Acute kidney injury after successful cardiopulmonary resuscitation; risk factors and prognosis: a retrospective cross-sectional study

Farhad Heydari; Mehdi Nasr Isfahani; Azita Azimi Meibody; Fleuria Flechon-Meibody; Javad Shahabi; Seyyed Taghi Hashemi; Omid Ahmadi; Neda Al Sadat Fatemi; Khatere Ghaznavi

doi:10.18502/fem.v6i4.10430

Farhad Heydari Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Mehdi Nasr Isfahani Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Azita Azimi Meibody Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Fleuria Flechon-Meibody Department of Nephrology, French Center for Nephrology and Hemodialysis, Metz, France.
Javad Shahabi Department of Cardiology, Cardiovascular Research Institute, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Seyyed Taghi Hashemi Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Omid Ahmadi Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Neda Al Sadat Fatemi Trauma Registry Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Khatere Ghaznavi Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

DOI: https://doi.org/10.18502/fem.v6i4.10430

Keywords: Acute Kidney Injury; Cardiac Arrest; Cardiopulmonary Resuscitation; Emergency Department

Abstract

Objective: Acute kidney injury (AKI) is an independent risk factor in critically ill patients. This study aimed to evaluate the prevalence of AKI in resuscitated cardiac arrest (CA) patients, its potential risk factors, and outcomes of AKI in cardiac arrest survivors.

Methods: A hundred and forty-nine cases of post-CA patients that survived for at least 24 hours, admitted to three hospitals between 2016 and 2020, were studied. AKI was defined by the RIFLE (Risk, Injury, Failure, Loss, and End-stage) criteria. Baseline demographic data, resuscitation variables, the prevalence of AKI, in-hospital and six-month mortality were collected. Logistic regression evaluated the factors associated with AKI occurrence and mortality.

Results: AKI occurred in 59 (39.6%) of the patients. Of these, 9 patients (15.3%) required renal replacement therapy (RRT) during their hospital stay. There were 47 (52.2%) in-hospital deaths in patients without AKI and 41 (69.5%) in patients with AKI (P=0.036). Post-CA AKI was significantly associated with six-month mortality (OR=1.65; 95% CI: 1.39,2.88; P=0.029). Older age, the higher cumulative dosage of epinephrine during cardiopulmonary resuscitation, post-CA shock, in-hospital CA, initial pulseless electrical activity (PEA) or asystole rhythm, longer duration of cardiac arrest, as well as higher admission creatinine and lactate levels were independently associated with AKI; in contrast, higher admission base excess level was negatively associated with AKI.

Conclusion: AKI occurred in nearly 40% of CA patients. AKI was associated with a higher in-hospital and six-month mortality rates.