by Malin Rundgren et al: Critical Care 2019 23:163
Background
To elucidate the incidence of acute kidney injury (AKI) after
out-of-hospital cardiac arrest (OHCA) and to examine the impact of target
temperature management (TTM) and early coronary angiography on renal function.
Methods
Post hoc analysis of the TTM trial, a multinational randomised
controlled trial comparing target temperature of 33 °C versus 36 °C in patients
with return of spontaneous circulation after OHCA. The impact of TTM and early
angiography (within 6 h of OHCA) versus late or no angiography on the
development of AKI during the 7-day period after OHCA was analysed. AKI was
defined according to modified KDIGO criteria in patients surviving beyond day 2
after OHCA.
Results
Following exclusions, 853 of 939 patients enrolled in the main trial
were analysed. Unadjusted analysis showed that significantly more patients in
the 33 °C group had AKI compared to the 36 °C group [211/431 (49%) versus
170/422 (40%) p = 0.01], with a worse severity (p = 0.018).
After multivariable adjustment, the difference was not significant (odds ratio
0.75, 95% confidence interval 0.54–1.06, p = 0.10].
Five hundred seventeen patients underwent early coronary angiography.
Although the unadjusted analysis showed less AKI and less severe AKI in
patients who underwent early angiography compared to patients with late or no
angiography, in adjusted analyses, early angiography was not an independent
risk factor for AKI (odds ratio 0.73, 95% confidence interval 0.50–1.05, p = 0.09).
Conclusions
In OHCA survivors, TTM at 33 °C compared to management at 36 °C did not
show different rates of AKI and early angiography was not associated with an
increased risk of AKI.
Trial registration
NCT01020916.
Registered on www.ClinicalTrials.gov 26 November 2009 (main trial).
No comments:
Post a Comment