Early postoperative administration of proton pump inhibitors and acute kidney injury after cardiac surgery
R An, B Wang, F YanAbstract
Aims
This study aimed to explore the effect of early postoperative proton pump inhibitors (PPI) administration on acute kidney injury (AKI) after cardiac surgery.
Methods
This study retrieved data on patients undergoing cardiac surgery from the Medical Information Mart for Intensive Care IV database. All patients were divided into the non-PPI group and PPI group according to whether they used PPI in the early postoperative period. The incidence of postoperative AKI, severe AKI (SAKI), length of intensive care unit stay (LOIS), length of hospital stay (LOHS), and postoperative mortality were compared between the two groups before and after propensity score matching (PSM). Then, the univariate logistic regression, multivariate logistic regression, PSM, and inverse probability of treatment weighting (IPTW) were performed respectively to evaluate the association between early postoperative PPI administration and AKI. Finally, subgroup and interaction analyses were performed to assess the interactions between early postoperative PPI administration and stratification variables.
Results
A total of 6559 patients were included in this study. 5667 (86.40%) patients used PPI, and 892 (13.60%) patients did not use PPI in the early postoperative period. After 1:1 PSM, there were 850 patients in each group of non-PPI and PPI with good balance. The incidence of postoperative AKI (88.94% vs. 83.88%, p = 0.002) and SAKI (64.71% vs. 58.82%, p = 0.013) in the PPI group was significantly higher than that in the non-PPI group. The LOIS (3.32 vs. 2.22, p < 0.001) and LOHS (9.96 vs. 8.27, p < 0.001) were significantly prolonged in the PPI group. The two groups had no significant difference in postoperative mortality. Early postoperative PPI administration was significantly associated with an increased risk of postoperative AKI and SAKI across univariate logistic regression, multivariate logistic regression, PSM and IPTW models. There was no interaction between early postoperative PPI administration and stratification variables.
Conclusions
Early postoperative PPI administration significantly increased the risk of postoperative AKI and SAKI and prolonged the LOIS and LOHS in cardiac surgery patients. Early postoperative PPI administration may be a modifiable perioperative risk factor for AKI after cardiac surgery.Figure 2