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

Research output: Contribution to journalArticle

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 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).

Details

Authors
  • Malin Rundgren
  • Susann Ullén
  • Matt P.G. Morgan
  • Guy Glover
  • Julius Cranshaw
  • Nawaf Al-Subaie
  • Andrew Walden
  • Michael Joannidis
  • Marlies Ostermann
  • Josef Dankiewicz
  • Niklas Nielsen
  • Matthew P. Wise
Organisations
External organisations
  • Cardiff University
  • Guy's and St Thomas' NHS Foundation Trust
  • Royal Bournemouth Hospital
  • St George's Hospital, London
  • Royal Berkshire Hospital
  • Skåne University Hospital
  • Helsingborg Hospital
  • University Hospital of Wales
  • King's College London
  • Medical University of Innsbruck
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Urology and Nephrology

Keywords

  • Acute kidney injury, Angiography, Contrast, Induced hypothermia (target temperature management), Out-of-hospital cardiac arrest
Original languageEnglish
Article number163
JournalCritical Care
Volume23
Issue number1
Publication statusPublished - 2019 May 8
Publication categoryResearch
Peer-reviewedYes