# 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.

## Key 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.