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. 2022 Jul 4;12(1):61.
doi: 10.1186/s13613-022-01037-1.

Association between acute kidney injury and norepinephrine use following cardiac surgery: a retrospective propensity score-weighted analysis

Pierre Huette  1 , Mouhamed Djahoum Moussa  2 , Christophe Beyls  1 , Pierre-Grégoire Guinot  3 , Mathieu Guilbart  1 , Patricia Besserve  1 , Mehdi Bouhlal  1 , Sarah Mounjid  1 , Hervé Dupont  1 , Yazine Mahjoub  1 , Audrey Michaud  4 , Osama Abou-Arab  5
Affiliations

Association between acute kidney injury and norepinephrine use following cardiac surgery: a retrospective propensity score-weighted analysis

Pierre Huette et al. Ann Intensive Care. .

Abstract

Background: Excess exposure to norepinephrine can compromise microcirculation and organ function. We aimed to assess the association between norepinephrine exposure and acute kidney injury (AKI) and intensive care unit (ICU) mortality after cardiac surgery.

Methods: This retrospective observational study included adult patients who underwent cardiac surgery under cardiopulmonary bypass from January 1, 2008, to December 31, 2017, at the Amiens University Hospital in France. The primary exposure variable was postoperative norepinephrine during the ICU stay and the primary endpoint was the presence of AKI. The secondary endpoint was in-ICU mortality. As the cohort was nonrandom, inverse probability weighting (IPW) derived from propensity scores was used to reduce imbalances in the pre- and intra-operative characteristics.

Results: Among a population of 5053 patients, 1605 (32%) were exposed to norepinephrine following cardiac surgery. Before weighting, the prevalence of AKI was 25% and ICU mortality 10% for patients exposed to norepinephrine. Exposure to norepinephrine was estimated to be significantly associated with AKI by a factor of 1.95 (95% confidence interval, 1.63-2.34%; P < 0.001) in the IPW cohort and with in-ICU mortality by a factor of 1.54 (95% confidence interval, 1.19-1.99%; P < 0.001).

Conclusion: Norepinephrine was associated with AKI and in-ICU mortality following cardiac surgery. While these results discourage norepinephrine use for vasoplegic syndrome in cardiac surgery, prospective investigations are needed to substantiate findings and to suggest alternative strategies for organ protection.

Keywords: Acute kidney injury; Cardiac surgery; Mortality; Norepinephrine; Propensity analysis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of participants. CPB: cardiopulmonary bypass, ICU: intensive care unit
Fig. 2
Fig. 2
Love plots for standardized mean differences comparing covariate values before (grey triangle) and after (blue triangle) propensity score weighting for the assessment of acute kidney injury (A) and in-ICU mortality (B). Standardized mean differences are expressed as percentages. An absolute MSD < 15% was considered to support the assumption of balance between the groups. BMI: body-mass index, CABG: coronary bypass graft, CPB: cardiopulmonary bypass, SAPS II: Simplified Acute Physiology Score. *: inotropes include the use of dobutamine or epinephrine associated or not to norepinephrine
See this image and copyright information in PMC

References

    1. Shaefi S, Mittel A, Klick J, Evans A, Ivascu NS, Gutsche J, et al. Vasoplegia after cardiovascular procedures-pathophysiology and targeted therapy. J Cardiothorac Vasc Anesth. 2017;32(2):1013–1022. doi: 10.1053/j.jvca.2017.10.032. - DOI - PubMed
    1. Vail EA, Shieh M-S, Pekow PS, Gershengorn HB, Walkey AJ, Lindenauer PK, et al. Use of vasoactive medications after cardiac surgery in the United States. Ann Am Thorac Soc. 2021;18:103–111. doi: 10.1513/AnnalsATS.202005-465OC. - DOI - PMC - PubMed
    1. Regueira T, Bänziger B, Djafarzadeh S, Brandt S, Gorrasi J, Takala J, et al. Norepinephrine to increase blood pressure in endotoxaemic pigs is associated with improved hepatic mitochondrial respiration. Crit Care. 2008;12:R88. doi: 10.1186/cc6956. - DOI - PMC - PubMed
    1. Hajjar LA, Vincent JL, Barbosa Gomes Galas FR, Rhodes A, Landoni G, Osawa EA, et al. Vasopressin versus norepinephrine in patients with vasoplegic shock after cardiac surgery: the VANCS randomized controlled trial. Anesthesiology. 2017;126:85–93. doi: 10.1097/ALN.0000000000001434. - DOI - PubMed
    1. McIntyre WF, Um KJ, Alhazzani W, Lengyel AP, Hajjar L, Gordon AC, et al. Association of vasopressin plus catecholamine vasopressors vs catecholamines alone with atrial fibrillation in patients with distributive shock: a systematic review and meta-analysis. JAMA. 2018;319:1889. doi: 10.1001/jama.2018.4528. - DOI - PMC - PubMed