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

ABSTRACT

Background: 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. Methods: 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 ( VIS max ). Results: 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 VIS max was associated with AKI stage 1-2 (aOR 2.51, 95% CI 1.20-5.24), whereas a high VIS max was associated with an increased risk for AKI stage 3 (aOR 2.46, 95% CI 1.28-4.75). Conclusions: Early AKI is associated with an increased risk of in-hospital mortality and unfavorable neurologic recovery in cardiac arrest survivors. Postarrest VIS max is an independent predictor of the development and severity of AKI following ROSC, regardless of baseline kidney function.