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Hemodilution is Associated with Underestimation of Serum Creatinine in Cardiac Surgery Patients: A retrospective analysis
Xiaoqiang Ding
Zhongshan Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0169-2729
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Fluid overload is related to the development and prognosis of cardiac surgery-associated acute kidney injury (CSA-AKI). The study is to investigate the influence of serum creatinine (SCr) corrected by fluid balance on the prognosis of patients with cardiac surgery.
Methods: A retrospective study was conducted in 1334 patients who underwent elective cardiac surgery from January 1 to December 31, 2015. Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI were applied to identify CSA-AKI. SCr was measured every 24 hours during ICU period and was accordingly adjusted for cumulative fluid balance. Changes in SCr, defined as ∆Crea, were determined by difference between before and after adjustment for cumulative fluid balance. All patients were then divided into three groups: underestimation group (∆Crea ≥ P75), normal group (P25 < ∆Crea < P75) and overestimation group (∆Crea ≤ P25).
Results: The incidence of AKI increased from 29.5% to 31.8% after adjustment for fluid balance. Patients in underestimation group showed prolonged length of ICU stay compared with normal group and overestimation group (3.2[1.0-4.0] vs 2.1[1.0-3.0] d, P < 0.001; 3.2[1.0-4.0] vs 2.3[1.0-3.0] d, P < 0.001). Length of hospital stay and mechanical ventilation dependent days in underestimation group were significantly longer than normal group (P < 0.001). Multivariate analysis showed age, baseline SCr and left ventricular ejection fraction were independently associated with underestimation of creatinine.
Conclusions: Cumulative fluid balance after cardiac surgery disturbs accurate measurement of serum creatinine. Patients with underestimation of SCr were associated with poor prognosis.
Keywords
Acute kidney injury, Fluid balance, Cardiac surgery, Diagnosis, Prognosis
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On 15 Dec, 2020
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Editorial decision: Major revision
On 06 Dec, 2020
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Received 29 Nov, 2020
Review #2 received
Received 26 Nov, 2020
Reviewer #2 agreed
On 09 Nov, 2020
Reviewers invited
Invitations sent on 09 Nov, 2020
Reviewer #1 agreed
On 09 Nov, 2020
Editor assigned
On 12 Oct, 2020
Submission checks complete
On 11 Oct, 2020
Editor invited
On 11 Oct, 2020
No comments provided
Editorial decision: Major revision
On 27 Aug, 2020
Review #2 received
Received 12 Aug, 2020
Reviewer #2 agreed
On 05 Aug, 2020
Review #1 received
Received 17 Jun, 2020
Reviewer #1 agreed
On 02 Jun, 2020
Reviewers invited
Invitations sent on 31 May, 2020
Editor assigned
On 05 May, 2020
First submitted
On 04 May, 2020
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On 04 May, 2020
Editor invited
On 04 May, 2020
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This preprint is under consideration at BMC Cardiovascular Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Hemodilution is Associated with Underestimation of Serum Creatinine in Cardiac Surgery Patients: A retrospective analysis
Xiaoqiang Ding
Zhongshan Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0169-2729
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 3
Posted 31 Dec, 2020
No community comments so far
Reviewers invited
Invitations sent on 28 Dec, 2020
Reviewer #1 agreed
On 28 Dec, 2020
Review #1 received
Received 28 Dec, 2020
Editor assigned
On 15 Dec, 2020
Submission checks complete
On 15 Dec, 2020
Editor invited
On 15 Dec, 2020
No comments provided
Editorial decision: Major revision
On 06 Dec, 2020
Review #1 received
Received 29 Nov, 2020
Review #2 received
Received 26 Nov, 2020
Reviewer #2 agreed
On 09 Nov, 2020
Reviewers invited
Invitations sent on 09 Nov, 2020
Reviewer #1 agreed
On 09 Nov, 2020
Editor assigned
On 12 Oct, 2020
Submission checks complete
On 11 Oct, 2020
Editor invited
On 11 Oct, 2020
No comments provided
Editorial decision: Major revision
On 27 Aug, 2020
Review #2 received
Received 12 Aug, 2020
Reviewer #2 agreed
On 05 Aug, 2020
Review #1 received
Received 17 Jun, 2020
Reviewer #1 agreed
On 02 Jun, 2020
Reviewers invited
Invitations sent on 31 May, 2020
Editor assigned
On 05 May, 2020
First submitted
On 04 May, 2020
Submission checks complete
On 04 May, 2020
Editor invited
On 04 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Fluid overload is related to the development and prognosis of cardiac surgery-associated acute kidney injury (CSA-AKI). The study is to investigate the influence of serum creatinine (SCr) corrected by fluid balance on the prognosis of patients with cardiac surgery.
Methods: A retrospective study was conducted in 1334 patients who underwent elective cardiac surgery from January 1 to December 31, 2015. Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI were applied to identify CSA-AKI. SCr was measured every 24 hours during ICU period and was accordingly adjusted for cumulative fluid balance. Changes in SCr, defined as ∆Crea, were determined by difference between before and after adjustment for cumulative fluid balance. All patients were then divided into three groups: underestimation group (∆Crea ≥ P75), normal group (P25 < ∆Crea < P75) and overestimation group (∆Crea ≤ P25).
Results: The incidence of AKI increased from 29.5% to 31.8% after adjustment for fluid balance. Patients in underestimation group showed prolonged length of ICU stay compared with normal group and overestimation group (3.2[1.0-4.0] vs 2.1[1.0-3.0] d, P < 0.001; 3.2[1.0-4.0] vs 2.3[1.0-3.0] d, P < 0.001). Length of hospital stay and mechanical ventilation dependent days in underestimation group were significantly longer than normal group (P < 0.001). Multivariate analysis showed age, baseline SCr and left ventricular ejection fraction were independently associated with underestimation of creatinine.
Conclusions: Cumulative fluid balance after cardiac surgery disturbs accurate measurement of serum creatinine. Patients with underestimation of SCr were associated with poor prognosis.
Figure 1