Impact of Postarrest Vasoactive-Inotropic Score on Acute Kidney Injury in Cardiac Arrest Survivors: A Retrospective Cohort Study

TL;DR

This study shows that higher vasoactive-inotropic scores after cardiac arrest are linked to more severe kidney injury and worse outcomes.

Contribution

The study identifies VISmax as an independent predictor of AKI severity in cardiac arrest survivors.

Findings

181 out of 411 patients developed early AKI after ROSC.

High VISmax was associated with AKI stage 3, while low VISmax was linked to AKI stages 1–2.

AKI was tied to higher mortality and worse neurological outcomes.

Abstract

Postarrest acute kidney injury (AKI) is a major health
burden because it is associated with prolonged hospitalization, increased
dialysis requirement, high mortality, and unfavorable neurological outcomes.
Managing hemodynamic instability during the early postarrest period is critical;
however, the role of quantified vasopressor dependence in AKI development in
relation to illness severity remains unclear.

A retrospective,
observational cohort study that enrolled 411 non-traumatic adult cardiac arrest
survivors without pre-arrest end-stage kidney disease between January 2017 and
December 2019, grouped according to their baseline kidney function. The criteria
for kidney injury were based on the Kidney Disease: Improving Global Outcomes
definition and AKI staging system. The degree of vasopressor dependence within
the first 24 h following return of spontaneous circulation (ROSC) was presented
using the maximum vasoactive-inotropic score (VISmax).

Of
the 411 patients, 181 (44%) had early AKI after ROSC. Patients with AKI showed
an increased risk of in-hospital mortality (adjusted OR [aOR] 5.40, 95% CI 3.36–8.69,
p
< 0.001) and unfavorable neurological outcome (aOR
5.70, 95% CI 3.45–9.43, p
< 0.001) compared to patients without AKI.
The risk of adverse outcomes increased with illness severity. Patients with
vasopressor support had an increased risk of early AKI. A low VISmax was
associated with AKI stage 1–2 (aOR 2.51, 95% CI 1.20–5.24), whereas a high
VISmax was associated with an increased risk for AKI stage 3 (aOR 2.46, 95%
CI 1.28–4.75).

Early AKI is associated with an increased
risk of in-hospital mortality and unfavorable neurologic recovery in cardiac
arrest survivors. Postarrest VISmax is an independent predictor of the
development and severity of AKI following ROSC, regardless of baseline kidney
function.

Figures