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Baseline Pulse Pressure, Acute Kidney Injury, and Mortality After Noncardiac Surgery

Oprea, Adriana D. MD; Lombard, Frederick W. MB, ChB, FANZCA; Liu, Wen-Wei MSc; White, William D. MSc; Karhausen, Jörn A. MD; Li, Yi-Ju PhD; Miller, Timothy E. MB, ChB, FRCA; Aronson, Solomon MD, MBA; Gan, Tong J. MD, MHS, FRCA; Fontes, Manuel L. MD; Kertai, Miklos D. MD, PhD

doi: 10.1213/ANE.0000000000001557
Patient Safety: Original Clinical Research Report
Continuing Medical Education

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.

Supplemental Digital Content is available in the text.Published ahead of print September 7, 2016.

From the *Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut; Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina; §Division of General, Vascular, and Transplant Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; and Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York.

Published ahead of print September 7, 2016.

Accepted for publication July 7, 2016.

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Presented as a poster at the Outcomes and Database Research Poster Session at the American Society of Anesthesiologists Annual Meeting, October 27, 2015.

Adriana D. Oprea, MD, Frederick W. Lombard, MB, ChB, FANZCA, Manuel L. Fontes, MD, and Miklos D. Kertai, MD, PhD, contributed equally to this work, and should be considered co-first and co-senior authors.

Reprints will not be available from the authors.

Address correspondence to Miklos D. Kertai, MD, PhD, Duke University Medical Center, Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, 5693 HAFS Bldg, Durham, NC 27710. Address e-mail to miklos.kertai@duke.edu.

© 2016 International Anesthesia Research Society