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Critical Care
Published in: Critical Care 1/2019

Open Access 01-12-2019 | Acute Kidney Injury | Research

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

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

Published in: Critical Care | Issue 1/2019

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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).
Appendix
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Metadata
Title
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
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
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2019
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-019-2390-0

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