Impairment of renal function in patients resuscitated from cardiac arrest:frequency, determinants and impact on outcome

Objective: To assess frequency, determinants and impact on outcome of impai red renal function in cardiac arrest survivors. Patients and methods: In a retrospective analysis 87 patients admitted afte r cardiac arrest to an emergency department between 1 March 1994 and 31 Oct ober 1995 were evaluated; patients were followed until 31 December 1998 or death. Serum creatinine was measured on arrival, 24 hours, 3 and 7 days aft er cardiac arrest. Impaired renal function was subclassified according to s everity differentiating in between cases with an elevation of serum creatin ine level >1.4 mg/dl to 2 mg/dl and >2 mg/dl. We examined the association b etween prearrest history and CPR data, collected according to the "Utstein Style", acid renal function. Results: Patients were followed for a median of 1199 days (IQR 16 to 1427). Impaired renal function (serum creatinine level >1.4 mg/dl) was found on a dmission in 36 patients (41%), at 24 hours in 24 (31%), at 3 days in 13 (19 %) and on day seven in 9 patients (16%) respectively. History of congestive heart failure and duration of low flow state (from th e beginning of basic and/or advanced life support until restoration of spon taneous circulation) were significantly associated with elevated serum crea tinine (>1.4 mg/dl) at 24 hours after the event. The occurrence of impaired renal function was also more frequent in patients with diabetes mellitus a nd hypertension, but this did not reach statistical significance. The relat ive risk for death was 2.8 (95% confidence interval 1.3-5.8) for a serum cr eatinine level of >1.4 mg/dl to 2.0 mg/dl and 5.4 (95% confidence interval 2.4-12.1) for values >2 mg/dl. Conclusion: Transient impaired renal function is common in patients survivi ng cardiac arrest. Congestive heart failure and low flow time are independe nt predictors for the development of impaired renal function. There is a po sitive association in between increased serum creatinine levels and risk of death.