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

Yu-Tzu Tien; Wen-Jone Chen; Chien-Hua Huang; Wei-Ting Chen; Hooi-Nee Ong; Tao-Ming Huang; Wei-Tien Chang; Min-Shan Tsai

doi:10.31083/j.rcm2501004

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

Rev Cardiovasc Med. 2024 Jan 4;25(1):4. doi: 10.31083/j.rcm2501004. eCollection 2024 Jan.

Authors

Yu-Tzu Tien¹, Wen-Jone Chen^{1

2}, Chien-Hua Huang¹, Wei-Ting Chen¹, Hooi-Nee Ong¹, Tao-Ming Huang³, Wei-Tien Chang¹, Min-Shan Tsai¹

Affiliations

¹ Department of Emergency Medicine, National Taiwan University Medical College and Hospital, 100233 Taipei, Taiwan.
² Department of Internal Medicine (Cardiology Division), National Taiwan University Medical College and Hospital, 100233 Taipei, Taiwan.
³ Department of Internal Medicine (Nephrology Division), National Taiwan University Medical College and Hospital, 100233 Taipei, Taiwan.

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.

Keywords: AKI staging; acute kidney injury; baseline kidney function; cardiac arrest; vasoactive inotropic score.