Objectives: To determine whether preoperative endothelial dysfunction provides risk stratification for perioperative renal injury in patients undergoing noncardiac surgery. The relationship between perioperative renal injury and myocardial injury after noncardiac surgery (MINS) was explored secondarily. Design: An observational study. Setting: Two academic medical centers. Participants: A total of 218 patients scheduled to undergo intermediate or high-risk noncardiac surgery. Interventions: None. Measurements and Main Results: Endothelial dysfunction was identified preoperatively by a Reactive Hyperemia-Peripheral Arterial Tonometry (RH-PAT) index. Renal injury was defined by peak delta serum creatinine (Delta S-cr) or creatinine-based kidney disease: Improving global outcomes acute kidney injury (AKI) criteria within 7 days postoperatively. MINS was defined by peak troponin >= 0.04 mu g/L within 3 days postoperatively. AKI occurred in 22 patients (10.1%). Median RH-PAT index within the study cohort was 1.64 (range 1.03-4.96) and did not differ between patients with or without AKI. When adjusted for covariates, there was no association between RH-PAT index and either AKI or peak Delta S-cr. MINS occurred in 32 patients (14.7%) and was associated independently with the outcome of AKI (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.2-10.8; p = 0.02) and peak Delta S-cr. (beta-regression coefficient 23; 95% CI, 9-37; p = 0.002). Co-occurrence of AKI and MINS portended a marked increase in 30-day mortality (OR, 43; 95% CI, 6-305; p = 0.001) and delayed time to discharge (hazard ratio, 0.27; 95% CI, 0.13-0.54; p = 0.001). Conclusions: For patients undergoing noncardiac surgery, preoperative endothelial function assessed by noninvasive peripheral arterial tonometry was not associated with penoperative AKI. Perioperative renal injury was associated strongly with MINS, and this may represent a mechanism by which AKI increases adverse outcomes. Crown Copyright (C) 2015 Published by Elsevier Inc. All rights reserved.
基金：
Australian and New Zealand College of Anaesthestists [08/016]; Health and Health Services Research Fund [07080421]; General Research Fund [461409]; Research Grant Council of Hong KongHong Kong Research Grants Council
语种：
外文
被引次数：
WOS：
PubmedID：
中科院(CAS)分区：
出版当年[2014]版：
大类|4 区医学
小类|4 区麻醉学4 区心脏和心血管系统4 区外周血管病4 区呼吸系统
最新[2023]版：
大类|4 区医学
小类|4 区麻醉学4 区心脏和心血管系统4 区外周血管病4 区呼吸系统
JCR分区：
出版当年[2013]版：
Q3CARDIAC & CARDIOVASCULAR SYSTEMSQ3ANESTHESIOLOGYQ4PERIPHERAL VASCULAR DISEASEQ4RESPIRATORY SYSTEM
第一作者机构：[1]Alfred Hosp, Dept Anaesthesia & Perioperat Med, Melbourne, Vic 3004, Australia;[2]Monash Univ, Melbourne, Vic 3004, Australia;[3]Columbia Univ, Coll Phys & Surg, Dept Anesthesiol, New York, NY USA;
通讯作者：
通讯机构：[1]Alfred Hosp, Dept Anaesthesia & Perioperat Med, Melbourne, Vic 3004, Australia;[2]Monash Univ, Melbourne, Vic 3004, Australia;[3]Columbia Univ, Coll Phys & Surg, Dept Anesthesiol, New York, NY USA;[6]Alfred Hosp, Dept Anaesthesia & Perioperat Med, 55 Commercial Rd, Melbourne, Vic 3004, Australia
推荐引用方式(GB/T 7714)：
McIlroy David R.,Chan Matthew T. V.,Wallace Sophie K.,et al.Is Preoperative Endothelial Dysfunction a Potentially Modifiable Risk Factor for Renal Injury Associated With Noncardiac Surgery?[J].JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA.2015,29(5):1220-1228.doi:10.1053/j.jvca.2015.05.116.
APA：
McIlroy, David R.,Chan, Matthew T. V.,Wallace, Sophie K.,Grover, Arvinder,Koo, Emily G. Y....&Myles, Paul S..(2015).Is Preoperative Endothelial Dysfunction a Potentially Modifiable Risk Factor for Renal Injury Associated With Noncardiac Surgery?.JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA,29,(5)
MLA：
McIlroy, David R.,et al."Is Preoperative Endothelial Dysfunction a Potentially Modifiable Risk Factor for Renal Injury Associated With Noncardiac Surgery?".JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA 29..5(2015):1220-1228
