Recovery from acute kidney injury as a potent predictor of survival and good updates neurological outcome at discharge after out-of-hospital cardiac arrest

Abstract

Background: Acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) is a well-known predictor for mortality. However, the natural course of AKI including recovery rate after OHCA is uncertain. This study investigated the clinical course of AKI after OHCA and determined whether recovery from AKI impacted the outcomes of OHCA. Methods: This retrospective multicentre cohort study included adult OHCA patients treated with targeted temperature management (TTM) between January 2016 and December 2017. All was diagnosed using the Kidney Disease: Improving Global Outcomes criteria. The primary outcome was the recovery rate after AKI and its association with survival and good neurological outcome at discharge. Results: A total of 3697 OHCA patients from six hospitals were screened and 275 were finally included. AKI developed in 175/275 (64%) patients and 69/175 (39%) patients recovered from AKI. In most cases, All developed within three days of return of spontaneous circulation [155/175 (89%), median time to All development 1 (1-2) day] and patients recovered within seven days of return of spontaneous circulation [59/69 (86%), median time to AKI recovery 3 (2-7) days]. Duration of AKI was significantly longer in the All non-recovery group than in the All recovery group [5 (2-9) vs. 1 (1-5) days; P < 0.001]. Most patients were diagnosed with AKI stage 1 initially [120/175 (69%)]. However, the number of stage 3 AKI patients increased from 30/175 (17%) to 77/175 (44%) after the initial diagnosis of AKI. The rate of survival discharge was significantly higher in the All recovery group than in the AKI non-recovery group [45/69 (65%) vs. 17/106 (16%); P < 0.001]. Recovery from AKI was a potent predictor of survival and good neurological outcome at discharge in the multivariate analysis (adjusted odds ratio, 8308; 95% confidence interval, 3.120-22.123; P < 0.001 and adjusted odds ratio, 36.822; 95% confidence interval, 4.097-330.926; P = 0.001). Conclusions: In our cohort of adult OHCA patients treated with TIM (n = 275), the recovery rate from All after OHCA was 39%, and recovery from AKI was a potent predictor of survival and good neurological outcome at discharge.