Early Postoperative Acetaminophen Administration and Severe Acute Kidney Injury After Cardiac Surgery

医学 急性肾损伤 对乙酰氨基酚 危险系数 回顾性队列研究 围手术期 内科学 队列 麻醉 队列研究 外科 置信区间
作者
Chao Xiong,Yuan Jia,Xie Wu,Yanyan Zhao,Su Yuan,Fuxia Yan,Daniel I. Sessler
出处
期刊:American Journal of Kidney Diseases [Elsevier BV]
卷期号:81 (6): 675-683.e1 被引量:22
标识
DOI:10.1053/j.ajkd.2022.11.009
摘要

Rationale & ObjectiveOxidative stress may contribute to the development of acute kidney injury (AKI) after cardiac surgery. Acetaminophen can be considered an antioxidant because it inhibits hemoprotein-catalyzed lipid peroxidation. We hypothesized that perioperative acetaminophen administration is associated with reduced AKI after cardiac surgery.Study DesignRetrospective observational cohort study.Setting & ParticipantsPatients aged ≥18 years who had cardiac surgery were identified from 2 publicly available clinical registries: the Medical Information Mart for Intensive Care III (MIMIC-III) and the eICU Collaborative Research Database (eICU).ExposureAdministration of acetaminophen in the first 48 hours after surgery.OutcomeSevere AKI in the first 7 days after surgery, defined as stage 2 or stage 3 AKI according to KDIGO criteria.Analytical ApproachMultivariable cause-specific hazards regression analysis.ResultsWe identified 5,791 patients from the MIMIC-III and 3,840 patients from the eICU registries. The overall incidence of severe AKI was 58% (3,390 patients) in the MIMIC-III cohort and 37% (1,431 patients) in the eICU cohort. Acetaminophen was administered in the early postoperative period to 4,185 patients (72%) and 2,737 patients (71%) in these 2 cohorts, respectively. In multivariable regression models, early postoperative use of acetaminophen was associated with a lower risk of severe AKI in both the MIMIC-III (adjusted hazard ratio [AHR], 0.86 [95% CI, 0.79-0.94]) and eICU (AHR, 0.84 [95% CI, 0.72-0.97]) cohorts. The benefit was consistent across sensitivity and subgroup analyses.LimitationsNo data on acetaminophen dose.ConclusionsEarly postoperative acetaminophen administration was independently associated with a lower risk of severe AKI in adults recovering from cardiac surgery. Prospective trials are warranted to assess the extent to which the observed association is causal and estimate the extent to which acetaminophen administration might prevent or reduce the severity of AKI. Oxidative stress may contribute to the development of acute kidney injury (AKI) after cardiac surgery. Acetaminophen can be considered an antioxidant because it inhibits hemoprotein-catalyzed lipid peroxidation. We hypothesized that perioperative acetaminophen administration is associated with reduced AKI after cardiac surgery. Retrospective observational cohort study. Patients aged ≥18 years who had cardiac surgery were identified from 2 publicly available clinical registries: the Medical Information Mart for Intensive Care III (MIMIC-III) and the eICU Collaborative Research Database (eICU). Administration of acetaminophen in the first 48 hours after surgery. Severe AKI in the first 7 days after surgery, defined as stage 2 or stage 3 AKI according to KDIGO criteria. Multivariable cause-specific hazards regression analysis. We identified 5,791 patients from the MIMIC-III and 3,840 patients from the eICU registries. The overall incidence of severe AKI was 58% (3,390 patients) in the MIMIC-III cohort and 37% (1,431 patients) in the eICU cohort. Acetaminophen was administered in the early postoperative period to 4,185 patients (72%) and 2,737 patients (71%) in these 2 cohorts, respectively. In multivariable regression models, early postoperative use of acetaminophen was associated with a lower risk of severe AKI in both the MIMIC-III (adjusted hazard ratio [AHR], 0.86 [95% CI, 0.79-0.94]) and eICU (AHR, 0.84 [95% CI, 0.72-0.97]) cohorts. The benefit was consistent across sensitivity and subgroup analyses. No data on acetaminophen dose. Early postoperative acetaminophen administration was independently associated with a lower risk of severe AKI in adults recovering from cardiac surgery. Prospective trials are warranted to assess the extent to which the observed association is causal and estimate the extent to which acetaminophen administration might prevent or reduce the severity of AKI.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
白菜包子完成签到 ,获得积分10
1秒前
Bio应助狮子清明尊采纳,获得10
2秒前
透明木头块儿完成签到,获得积分10
3秒前
Owen应助Johnspeed采纳,获得10
5秒前
bai发布了新的文献求助20
5秒前
6秒前
6秒前
8秒前
yx_cheng应助xi采纳,获得30
8秒前
小蘑菇应助公孙世往采纳,获得10
10秒前
阿海发布了新的文献求助10
11秒前
lgh发布了新的文献求助10
11秒前
LZY发布了新的文献求助10
12秒前
ddm完成签到,获得积分10
12秒前
科研通AI5应助Ultraman45采纳,获得10
12秒前
lll发布了新的文献求助10
13秒前
15秒前
16秒前
xiaohuangya完成签到 ,获得积分10
16秒前
17秒前
17秒前
19秒前
guozao应助阿海采纳,获得10
20秒前
ttttt发布了新的文献求助10
20秒前
23秒前
冷静如松完成签到 ,获得积分10
23秒前
23秒前
辛勤迎海发布了新的文献求助10
23秒前
樊傲云发布了新的文献求助10
24秒前
25秒前
wwho_O完成签到,获得积分10
27秒前
28秒前
28秒前
28秒前
Ultraman45完成签到,获得积分10
29秒前
Ultraman45发布了新的文献求助10
30秒前
31秒前
fuje发布了新的文献求助10
31秒前
31秒前
科研通AI2S应助tfq200采纳,获得10
32秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
Picture Books with Same-sex Parented Families: Unintentional Censorship 700
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3976210
求助须知:如何正确求助?哪些是违规求助? 3520366
关于积分的说明 11203088
捐赠科研通 3256965
什么是DOI,文献DOI怎么找? 1798570
邀请新用户注册赠送积分活动 877738
科研通“疑难数据库(出版商)”最低求助积分说明 806516