• David R McIlroy, Matthew T V Chan, Sophie K Wallace, Arvinder Grover, Emily G Y Koo, Jiajia Ma, Joel A Symons, and Paul S Myles.
• Department of Anaesthesia & Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia;; Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, NY;. Electronic address: D.Mcilroy@alfred.org.au.
• J. Cardiothorac. Vasc. Anesth. 2015 Oct 1; 29 (5): 1220-8.

ObjectivesTo determine whether preoperative endothelial dysfunction provides risk stratification for perioperative renal injury in patients undergoing noncardiac surgery. The relationship between perioperative renal injury and myocardial injury after noncardiac surgery (MINS) was explored secondarily.DesignAn observational study.SettingTwo academic medical centers.ParticipantsA total of 218 patients scheduled to undergo intermediate or high-risk noncardiac surgery.InterventionsNone.Measurements And Main ResultsEndothelial dysfunction was identified preoperatively by a Reactive Hyperemia-Peripheral Arterial Tonometry (RH-PAT) index. Renal injury was defined by peak delta serum creatinine (ΔSCr) or creatinine-based kidney disease: Improving global outcomes acute kidney injury (AKI) criteria within 7 days postoperatively. MINS was defined by peak troponin ≥0.04 µg/L within 3 days postoperatively. AKI occurred in 22 patients (10.1%). Median RH-PAT index within the study cohort was 1.64 (range 1.03-4.96) and did not differ between patients with or without AKI. When adjusted for covariates, there was no association between RH-PAT index and either AKI or peak ΔSCr. MINS occurred in 32 patients (14.7%) and was associated independently with the outcome of AKI (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.2-10.8; p = 0.02) and peak ΔSCr (β-regression coefficient 23; 95% CI, 9-37; p = 0.002). Co-occurrence of AKI and MINS portended a marked increase in 30-day mortality (OR, 43; 95% CI, 6-305; p = 0.001) and delayed time to discharge (hazard ratio, 0.27; 95% CI, 0.13-0.54; p = 0.001).ConclusionsFor patients undergoing noncardiac surgery, preoperative endothelial function assessed by noninvasive peripheral arterial tonometry was not associated with perioperative AKI. Perioperative renal injury was associated strongly with MINS, and this may represent a mechanism by which AKI increases adverse outcomes.Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

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