Baseline Pulse Pressure, Acute Kidney Injury, and Mortality After Noncardiac Surgery.
Abstract
BACKGROUND: Increased pulse pressure (PP) is an important independent predictor of
cardiovascular outcome and acute kidney injury (AKI) after cardiac surgery. The objective
of this study was to determine whether elevated baseline PP is associated with postoperative
AKI and 30-day mortality after noncardiac surgery. METHODS: We evaluated 9125 adult
patients who underwent noncardiac surgery at Duke University Medical Center between
January 2006 and December 2009. Baseline arterial blood pressure was defined as the
mean of the first 5 measurements recorded by the automated record keeping system before
inducing anesthesia. Multivariable logistic regression analysis was performed to determine
whether baseline PP adjusted for other perioperative risk factors was independently
associated with postoperative AKI and 30-day mortality. RESULTS: Of the 9125 patients,
the baseline PP was <40 mm Hg in 1426 (15.6%), 40-80 mm Hg in 6926 (75.9%), and >80
mm Hg in 773 (8.5%) patients. The incidence of AKI was 19.8%, which included 8.4%
(151 patients) and 4.2% (76 patients) who experienced stage II and III AKI, respectively.
In the risk-adjusted model for postoperative AKI, elevated baseline PP was associated
with higher odds for postoperative AKI (adjusted odds ratio [OR] for every 20 mm Hg
increase in PP, 1.17; 95% confidence interval [CI], 1.10-1.25; P < .0001). Also elevated
baseline preoperative PP was significantly associated with mild (stage I; OR, 1.19;
95% CI, 1.11-1.27; P < .0001), but not with more advanced stages of postoperative
AKI or with an incremental risk for 30-day mortality. CONCLUSIONS: We found a significant
association between elevated baseline PP and postoperative AKI in patients who underwent
noncardiac surgery. However, elevated PP was not significantly associated with more
advanced stages of postoperative AKI or 30-day mortality in these patients.
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https://hdl.handle.net/10161/13945Published Version (Please cite this version)
10.1213/ANE.0000000000001557Publication Info
Oprea, Adriana D; Lombard, Frederick W; Liu, Wen-Wei; White, William D; Karhausen,
Jörn A; Li, Yi-Ju; ... Kertai, Miklos D (2016). Baseline Pulse Pressure, Acute Kidney Injury, and Mortality After Noncardiac Surgery.
Anesth Analg, 123(6). pp. 1480-1489. 10.1213/ANE.0000000000001557. Retrieved from https://hdl.handle.net/10161/13945.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Solomon Aronson
Professor Emeritus of Anesthesiology
Solomon Aronson, MD, MBA, FACC, FACCP, FAHA, FASE
Solomon Aronson is a tenured professor at Duke University and Executive Vice Chairman
in the Department of Anesthesiology.
Dr. Aronson earned his BS in molecular biology with distinction at the University
of Wisconsin in Madison, and his MD with honors in research at the Medical College
of Wisconsin in Milwaukee. After completing an anesthesiology residency including
a year as chief resident at the Univer
Jorn Karhausen
Adjunct Associate Professor in the Department of Anesthesiology
Miklos David Kertai
Associate Professor of Anesthesiology
Yi-Ju Li
Professor of Biostatistics & Bioinformatics
My research interest is in statistical genetics, including statistical method development
and its application for understanding the genetic predisposition of human complex
diseases. Here is the list of research topics:
Statistical genetics: development of family-based association methods for quantitative
traits with or without censoring and for detecting X-linked genes for disease risk.
With the availability of next generation sequencing data, we have ongoing projects
to d
Frederick Wilhelm Lombard
Adjunct Associate Professor in the Department of Anesthesiology
1. Animal models of Subarachnoid Hemorrhage (SAH) induced Cerebral Vasospasm 2. Pathogenesis
of Cerebral Vasospasm following SAH 3. Translational Research in SAH 4. Long-term
Outcome following Endovascular Coiling of Unruptured Cerebral Aneurysms
Timothy Ellis Miller
Professor of Anesthesiology
Clinical and research interests are Enhanced Recovery and Perioperative Medicine;
with particular interests in fluid management, and perioperative optimization of the
high-risk non-cardiac surgery patient.
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