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Renal function after out-of-hospital cardiac arrest; The influence of temperature management and coronary angiography, a post hoc study of the target temperature management trial

Rundgren, Malin LU ; Ullén, Susann LU ; Morgan, Matt P.G. ; Glover, Guy ; Cranshaw, Julius ; Al-Subaie, Nawaf ; Walden, Andrew ; Joannidis, Michael ; Ostermann, Marlies and Dankiewicz, Josef LU , et al. (2019) In Critical Care 23(1).
Abstract

Background: To elucidate the incidence of acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) and to examine the impact of target temperature management (TTM) and early coronary angiography on renal function. Methods: Post hoc analysis of the TTM trial, a multinational randomised controlled trial comparing target temperature of 33 °C versus 36 °C in patients with return of spontaneous circulation after OHCA. The impact of TTM and early angiography (within 6 h of OHCA) versus late or no angiography on the development of AKI during the 7-day period after OHCA was analysed. AKI was defined according to modified KDIGO criteria in patients surviving beyond day 2 after OHCA. Results: Following exclusions, 853 of 939 patients... (More)

Background: To elucidate the incidence of acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) and to examine the impact of target temperature management (TTM) and early coronary angiography on renal function. Methods: Post hoc analysis of the TTM trial, a multinational randomised controlled trial comparing target temperature of 33 °C versus 36 °C in patients with return of spontaneous circulation after OHCA. The impact of TTM and early angiography (within 6 h of OHCA) versus late or no angiography on the development of AKI during the 7-day period after OHCA was analysed. AKI was defined according to modified KDIGO criteria in patients surviving beyond day 2 after OHCA. Results: Following exclusions, 853 of 939 patients enrolled in the main trial were analysed. Unadjusted analysis showed that significantly more patients in the 33 °C group had AKI compared to the 36 °C group [211/431 (49%) versus 170/422 (40%) p = 0.01], with a worse severity (p = 0.018). After multivariable adjustment, the difference was not significant (odds ratio 0.75, 95% confidence interval 0.54-1.06, p = 0.10]. Five hundred seventeen patients underwent early coronary angiography. Although the unadjusted analysis showed less AKI and less severe AKI in patients who underwent early angiography compared to patients with late or no angiography, in adjusted analyses, early angiography was not an independent risk factor for AKI (odds ratio 0.73, 95% confidence interval 0.50-1.05, p = 0.09). Conclusions: In OHCA survivors, TTM at 33 °C compared to management at 36 °C did not show different rates of AKI and early angiography was not associated with an increased risk of AKI. Trial registration: NCT01020916. Registered on www.ClinicalTrials.gov 26 November 2009 (main trial).

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type
Contribution to journal
publication status
published
subject
keywords
Acute kidney injury, Angiography, Contrast, Induced hypothermia (target temperature management), Out-of-hospital cardiac arrest
in
Critical Care
volume
23
issue
1
article number
163
publisher
BioMed Central (BMC)
external identifiers
  • pmid:31068215
  • scopus:85065500654
ISSN
1364-8535
DOI
10.1186/s13054-019-2390-0
language
English
LU publication?
yes
id
0703104e-302b-4a9c-8b9e-3024c43b69fc
date added to LUP
2019-05-21 21:43:01
date last changed
2020-10-20 01:09:02
@article{0703104e-302b-4a9c-8b9e-3024c43b69fc,
  abstract     = {<p>Background: To elucidate the incidence of acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) and to examine the impact of target temperature management (TTM) and early coronary angiography on renal function. Methods: Post hoc analysis of the TTM trial, a multinational randomised controlled trial comparing target temperature of 33 °C versus 36 °C in patients with return of spontaneous circulation after OHCA. The impact of TTM and early angiography (within 6 h of OHCA) versus late or no angiography on the development of AKI during the 7-day period after OHCA was analysed. AKI was defined according to modified KDIGO criteria in patients surviving beyond day 2 after OHCA. Results: Following exclusions, 853 of 939 patients enrolled in the main trial were analysed. Unadjusted analysis showed that significantly more patients in the 33 °C group had AKI compared to the 36 °C group [211/431 (49%) versus 170/422 (40%) p = 0.01], with a worse severity (p = 0.018). After multivariable adjustment, the difference was not significant (odds ratio 0.75, 95% confidence interval 0.54-1.06, p = 0.10]. Five hundred seventeen patients underwent early coronary angiography. Although the unadjusted analysis showed less AKI and less severe AKI in patients who underwent early angiography compared to patients with late or no angiography, in adjusted analyses, early angiography was not an independent risk factor for AKI (odds ratio 0.73, 95% confidence interval 0.50-1.05, p = 0.09). Conclusions: In OHCA survivors, TTM at 33 °C compared to management at 36 °C did not show different rates of AKI and early angiography was not associated with an increased risk of AKI. Trial registration: NCT01020916. Registered on www.ClinicalTrials.gov 26 November 2009 (main trial).</p>},
  author       = {Rundgren, Malin and Ullén, Susann and Morgan, Matt P.G. and Glover, Guy and Cranshaw, Julius and Al-Subaie, Nawaf and Walden, Andrew and Joannidis, Michael and Ostermann, Marlies and Dankiewicz, Josef and Nielsen, Niklas and Wise, Matthew P.},
  issn         = {1364-8535},
  language     = {eng},
  month        = {05},
  number       = {1},
  publisher    = {BioMed Central (BMC)},
  series       = {Critical Care},
  title        = {Renal function after out-of-hospital cardiac arrest; The influence of temperature management and coronary angiography, a post hoc study of the target temperature management trial},
  url          = {http://dx.doi.org/10.1186/s13054-019-2390-0},
  doi          = {10.1186/s13054-019-2390-0},
  volume       = {23},
  year         = {2019},
}