Mean platelet volume and cardiac-surgery–associated acute kidney injury: a retrospective study

• Published in: Canadian journal of anesthesia Vol. 67; no. 12; pp. 1775 - 1788
• Main Authors: Ramakrishnan, Abinaya, Zheng, Cynthia, Fontes, Manuel L., Lombard, Frederic W., Woolard, Austin A., Shi, Yaping, Shotwell, Matthew S., Billings, Frederic T., Pretorius, Mias, Wanderer, Jonathan P., Vyas, Rushikesh, Absi, Tarek S., Shah, Ashish S., Kertai, Miklos D.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2020; Springer Nature B.V
• Subjects: Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; Adult; Anesthesiology; Cardiac Surgical Procedures - adverse effects; Cardiology; Critical Care Medicine; Heart surgery; Humans; Intensive; Kidneys; Mean Platelet Volume; Medicine; Medicine & Public Health; Mortality; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Postoperative Complications - epidemiology; Postoperative period; Reports of Original Investigations; Retrospective Studies; Risk Factors; platelet count; mortality; cardiac surgery; acute kidney injury; mean platelet volume
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-020-01811-4

Purpose Increased mean platelet volume (MPV) may indicate platelet activation, platelet aggregation, and a resulting prothrombotic state. Such changes in the postoperative period have been associated with organ injury and adverse outcomes. We hypothesized that changes in MPV after cardiac surgery are associated with both a higher risk of acute kidney injury (AKI) and mortality. Methods In this retrospective study, we evaluated consecutive patients undergoing adult cardiac surgery patients between 12 December 2011 and 5 June 2018. The change in MPV was derived by calculating the difference between the baseline MPV before surgery and the average postoperative MPV just prior to the occurrence of AKI. We defined postoperative AKI according to Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for Acute Kidney Injury as either a ≥ 50% increase in serum creatinine in the first ten postoperative days, or an increase of ≥ 0.3 mg·dL −1 during any 48-hr window across the ten-day postoperative period. Multivariable logistic regression analysis was used to examine the association between MPV change and postoperative AKI and mortality. Results Of the 4,204 patients studied, 1,373 (32.7%) developed postoperative AKI, including 83 (2.0%) and 38 (0.9%) who developed stages II and III AKI, respectively. Compared with patients who had an increase in median postoperative MPV of 0.2 femtolitre (fL), those with an increase of 0.8 fL had an 80% increase in the odds of developing AKI (adjusted odds ratio [aOR], 1.80; 95% confidence interval [CI],1.36 to 2.38; P < 0.001) and were almost twice as likely to progress to a higher severity AKI (aOR, 1.66; 95% CI, 1.28 to 2.16; P < 0.001). Change in MPV was not associated with mortality (aOR,1.32; 95% CI, 0.92 to 1.89; P = 0.14). Conclusion Increased MPV change in the postoperative period was associated with both increased risk and severity of AKI, but not mortality.