Almost half out of 245 patients who were recuscitated after cardiac arrest developed acute kidney failure. The prognosis was poorer than for the other half of the patients.
The thesis of PhD candidate Sigrid Beitland of the University of Oslo focuses on kidney injury following cardiac arrest among patients at the Oslo University Hospital between 2010 and 2014. All patients were in coma after return of spontaneous circulation, and 46 % of them developed various degrees of acute kidney failure during the first three days in the hospital.
The first of Beitland’s two papers on cardiac arrest patients showed more than three times higher risk of dying during the next six months for patients with kidney injury compared to those who were free of kidney injury. Even after adjustments for potential confounders, the risk was more than doubled. Furthermore, the probability of having a good neurological outcome after six months was significantly reduced among patients with kidney failure.
In the second paper, the researchers analyzed urine samples from patients both within six hours after cardiac arrest and three days later. At both time points, the levels of the two proteins cystatin C and NGAL were on average higher in patients who developed acute kidney injury. The levels were also significantly linked to increased mortality and poor neurological outcome after six months. However, adding the biomarkers to clinical variables did not improve the ability to predict early death or impaired neurological function. Thus, there is limited clinical value of these findings.
Thesis: Acute kidney injury in trauma and cardiac arrest patients
Candidate: Sigrid Beitland
Time and place: February 17, 2017, University of Oslo
Beitland, S., Os, I., & Sunde, K. (2014). Primary injuries and secondary organ failures in trauma patients with acute kidney injury treated with continuous renal replacement therapy. Scientifica, 2014.
Beitland, S., Nakstad, E. R., Stær‐Jensen, H., Drægni, T., Andersen, G. Ø., Jacobsen, D., Brunborg, C, Waldum-Grevbo, B. & Sunde, K. (2016). Impact of acute kidney injury on patient outcome in out‐of‐hospital cardiac arrest: a prospective observational study. Acta Anaesthesiologica Scandinavica, 60(8), 1170-1181.
Beitland, S., Waldum-Grevbo, B. E., Nakstad, E. R., Berg, J. P., Trøseid, A. M. S., Brusletto, B. S., Brunborg, C., Anders, G. Ø. & Sunde, K. (2016). Urine biomarkers give early prediction of acute kidney injury and outcome after out-of-hospital cardiac arrest. Critical Care, 20(1), 314.