Baseline Pulse Pressure, Acute Kidney Injury, and Mortality After Noncardiac Surgery.
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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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Oprea, Adriana D, Frederick W Lombard, Wen-Wei Liu, William D White, Jörn A Karhausen, Yi-Ju Li, Timothy E Miller, Solomon Aronson, et al. (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.
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Scholars@Duke
Yi-Ju Li
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 develop the association methods for testing rare variants for different phenotypic measures.
- Genetics of Alzheimer's disease (AD) and Fuchs endothelial corneal dystrophy (FECD).
- Genetic basis of age-at-onset of Alzheimer disease.
- Peri-operative genomic studies. Investigate the genetic risk factors for postoperative outcomes of patients underwent non-emergent coronary artery bypass grafting with cardiopulmonary bypass.
Timothy Ellis Miller
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.
Solomon Aronson
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 University of Texas Medical Branch in Galveston, he completed a fellowship in cardiac and vascular anesthesia at the Texas Heart Institute in Houston. Thereafter was recruited to the University of Chicago where he ascending to the rank of full professor and served as chief of the cardiothoracic and vascular anesthesia division for 12 years. In 2011, Dr. Aronson received his MBA with a concentration in Health Sector Management at Duke University Fuqua School of Business.
Having written over 300 manuscripts, book chapters, abstracts as well as 5 textbooks, he is recognized as an expert on topics concerning perioperative echocardiography, surgical anticoagulation and blood management, perioperative blood pressure risk, healthcare strategy and health economics as well as other related topics in cardiovascular anesthesia and cardiology, he has lectured nationally and internationally.
Among the many research awards and lecture honors received over the years, Dr. Aronson has been repeatedly elected from among his peers to be listed in Best Doctors in America. Dr. Aronson continues to serve on the Joint Commission and AMA task force for overuse as well as the FDA as a consultant SGE after having served on the FDA as a member of the Anesthesia and Life support advisory committee and Anesthetic and Analgesic Drug Products Advisory Committee (AADPAC). He is an elected fellow of the American Heart Association, the American College of Chest Physicians, the American College of Cardiology, and the American Society of Echocardiography and an elective member of the Association of Cardiovascular Anesthesiologist and Association of University Anesthesiologists.
Dr. Aronson is the director of strategic business development for the Physicians Diagnostic Clinic (PDC), a 1600 member physician practice group at Duke and has severed as chair of the Finance Committee for the PDC in the past. He currently serves on the PDC Board of managers. He has served as a member of the economic committee of the American Society of Anesthesiologists for over 10 years and currently serves on the Future Models of Anesthesia Practice committee for the ASA. In addition, he served on the board of directors and was president of the intraoperative council in the American Society of Echocardiography and he also served on the board of directors and was president for the Society of Cardiovascular Anesthesiology. He remains on the board of trustees for the Society of Cardiovascular Anesthesiology and the Society of Cardiovascular Anesthesiology Foundation. He is a founding trustee member of the National Board of Echocardiography and has served on their board of directors. In 2013, he was elected to serve on the Science Accelerator Committee and the Leadership Committee for Cardiopulmonary, Critical Care, Perioperative & Resuscitation Council of the American Heart Association.
Dr. Aronson is married to Dr. Leena Sharma and they have 2 children – twins- in college. In addition to enjoying time with his family, he works at his tennis and golf games, listens to music, pursues drawing and painting interests and enjoys traveling and serving his community. He currently serves on the board of directors for the Boys and Girls Club of America in Durham.
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