Background

Excess exposure to norepinephrine can compromise microcirculation and organ function. We aimed to assess the association between norepinephrine exposure and acute kidney injury (AKI) and intensive care unit (ICU) mortality after cardiac surgery.

Methods

This retrospective observational study included adult patients who underwent cardiac surgery under cardiopulmonary bypass from January 1, 2008, to December 31, 2017, at the Amiens University Hospital in France. The primary exposure variable was postoperative norepinephrine during the ICU stay and the primary endpoint was the presence of AKI. The secondary endpoint was in-ICU mortality. As the cohort was nonrandom, inverse probability weighting (IPW) derived from propensity scores was used to reduce imbalances in the pre- and intra-operative characteristics.

Results

Among a population of 5053 patients, 1605 (32%) were exposed to norepinephrine following cardiac surgery. Before weighting, the prevalence of AKI was 25% and ICU mortality 10% for patients exposed to norepinephrine. Exposure to norepinephrine was estimated to be significantly associated with AKI by a factor of 1.95 (95% confidence interval, 1.63–2.34%; P < 0.001) in the IPW cohort and with in-ICU mortality by a factor of 1.54 (95% confidence interval, 1.19–1.99%; P < 0.001).

Conclusion

Norepinephrine was associated with AKI and in-ICU mortality following cardiac surgery. While these results discourage norepinephrine use for vasoplegic syndrome in cardiac surgery, prospective investigations are needed to substantiate findings and to suggest alternative strategies for organ protection.

中文翻译：

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心脏手术后急性肾损伤与去甲肾上腺素使用之间的关联：回顾性倾向评分加权分析

背景

过量接触去甲肾上腺素会损害微循环和器官功能。我们旨在评估去甲肾上腺素暴露与急性肾损伤（AKI）和心脏手术后重症监护病房（ICU）死亡率之间的关系。

方法

这项回顾性观察性研究包括从 2008 年 1 月 1 日至 2017 年 12 月 31 日在法国亚眠大学医院接受体外循环心脏手术的成年患者。主要暴露变量是ICU住院期间的术后去甲肾上腺素，主要终点是AKI的存在。次要终点是ICU死亡率。由于队列是非随机的，因此使用从倾向评分得出的逆概率加权 (IPW) 来减少术前和术中特征的不平衡。

结果

在 5053 名患者中，1605 名（32%）在心脏手术后暴露于去甲肾上腺素。在加权之前，暴露于去甲肾上腺素的患者的 AKI 患病率为 25%，ICU 死亡率为 10%。在 IPW 队列中，去甲肾上腺素暴露与 AKI 的显着相关性为 1.95 倍（95% 置信区间，1.63-2.34%；P  < 0.001），ICU 死亡率为 1.54 倍（95% 置信度）区间，1.19–1.99%；P  < 0.001）。

结论

去甲肾上腺素与心脏手术后 AKI 和 ICU 死亡率相关。虽然这些结果不鼓励在心脏手术中使用去甲肾上腺素治疗血管麻痹综合征，但需要进行前瞻性研究来证实这些发现并提出器官保护的替代策略。