Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

Acute kidney injury after out-of-hospital cardiac arrest: risk factors and prognosis in a large cohort

  • 863 Accesses

  • 39 Citations



Characteristics of acute kidney injury (AKI) occurring after out-of-hospital cardiac arrest (OHCA) are incompletely described. We aimed to evaluate the prevalence of AKI, identifying risk factors and assessing the impact of AKI on outcome after OHCA.


Single-center study between 2007 and 2012 in a cardiac arrest center in Paris, France. All consecutive OHCA patients with at least one weight measurement and one serum creatinine level available and treated by therapeutic hypothermia were included, except those with chronic kidney disease and those dead on arrival. AKI was defined as stage 3 of the Acute Kidney Injury Network (AKIN) classification. Main outcome was day-30 mortality. Factors associated with AKI occurrence and day-30 mortality were evaluated by logistic regression.


580 patients (71.3 % male, median age 59.3 years, initial shockable rhythm in 56.9 % of cases) were included in the analysis. AKI stage 3 occurred in 280 (48.3 %) patients. Age, male gender, resuscitation duration, post-resuscitation shock, public setting, and initial rhythm were associated with AKI stage 3. AKI stage 3 was associated with a significantly higher day-30 mortality rate [OR 1.60; 95 % CI (1.05, 2.43); p = 0.03]. No independent association between AKI and neurologic outcome was observed. At day 30, 67 patients had a normal kidney function (eGFR >75 mL/min/1.73 m2), and five remained dialysis-dependent. Patients with eGFR higher than 75 mL/min/1.73 m2 at day 30 were younger and more frequently male.


AKI stage 3 was frequent after OHCA and was associated with poorer outcome. Improvement strategies in post-resuscitation care should consider AKI as a potential target of treatment.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2


  1. 1.

    Atwood C, Eisenberg MS, Herlitz J, Rea TD (2005) Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation 67:75–80. doi:10.1016/j.resuscitation.2005.03.021

  2. 2.

    Sasson C, Rogers MAM, Dahl J, Kellermann AL (2010) Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 3:63–81. doi:10.1161/CIRCOUTCOMES.109.889576

  3. 3.

    Neumar RW, Nolan JP, Adrie C et al (2008) Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, Inter American Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation 118:2452–2483. doi:10.1161/CIRCULATIONAHA.108.190652

  4. 4.

    Lemiale V, Dumas F, Mongardon N et al (2013) Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort. Intensive Care Med 39:1972–1980. doi:10.1007/s00134-013-3043-4

  5. 5.

    Mongardon N, Dumas F, Ricome S et al (2011) Postcardiac arrest syndrome: from immediate resuscitation to long-term outcome. Ann Intensive Care 1:45. doi:10.1186/2110-5820-1-45

  6. 6.

    Mattana J, Singhal PC (1993) Prevalence and determinants of acute renal failure following cardiopulmonary resuscitation. Arch Intern Med 153:235–239

  7. 7.

    Domanovits H, Schillinger M, Müllner M et al (2001) Acute renal failure after successful cardiopulmonary resuscitation. Intensive Care Med 27:1194–1199

  8. 8.

    Domanovits H, Müllner M, Sterz F et al (2000) Impairment of renal function in patients resuscitated from cardiac arrest: frequency, determinants and impact on outcome. Wien Klin Wochenschr 112:157–161

  9. 9.

    Chua H-R, Glassford N, Bellomo R (2012) Acute kidney injury after cardiac arrest. Resuscitation 83:721–727. doi:10.1016/j.resuscitation.2011.11.030

  10. 10.

    O’Connor RE, Bossaert L, Arntz H-R et al (2010) Part 9: acute coronary syndromes: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 122:S422–S465. doi:10.1161/CIRCULATIONAHA.110.985549

  11. 11.

    Susantitaphong P, Alfayez M, Cohen-Bucay A et al (2012) Therapeutic hypothermia and prevention of acute kidney injury: a meta-analysis of randomized controlled trials. Resuscitation 83:159–167. doi:10.1016/j.resuscitation.2011.09.023

  12. 12.

    Zeiner A, Sunder-Plassmann G, Sterz F et al (2004) The effect of mild therapeutic hypothermia on renal function after cardiopulmonary resuscitation in men. Resuscitation 60:253–261. doi:10.1016/j.resuscitation.2003.11.006

  13. 13.

    Barrantes F, Tian J, Vazquez R et al (2008) Acute kidney injury criteria predict outcomes of critically ill patients. Crit Care Med 36:1397–1403. doi:10.1097/CCM.0b013e318168fbe0

  14. 14.

    Mandelbaum T, Scott DJ, Lee J et al (2011) Outcome of critically ill patients with acute kidney injury using the acute kidney injury network criteria. Crit Care Med 39:2659–2664. doi:10.1097/CCM.0b013e3182281f1b

  15. 15.

    Vaara ST, Pettilä V, Kaukonen K-M et al (2014) The attributable mortality of acute kidney injury: a sequentially matched analysis. Crit Care Med 42:878–885. doi:10.1097/CCM.0000000000000045

  16. 16.

    Uchino S, Kellum JA, Bellomo R et al (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818. doi:10.1001/jama.294.7.813

  17. 17.

    Abe D, Sato A, Hoshi T et al (2013) Clinical predictors of contrast-induced acute kidney injury in patients undergoing emergency versus elective percutaneous coronary intervention. Circ J 78:85–91

  18. 18.

    Tsai TT, Patel UD, Chang TI et al (2014) Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv 7:1–9. doi:10.1016/j.jcin.2013.06.016

  19. 19.

    Rihal CS, Textor SC, Grill DE et al (2002) Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation 105:2259–2264

  20. 20.

    Yanta J, Guyette FX, Doshi AA et al (2013) Renal dysfunction is common following resuscitation from out-of-hospital cardiac arrest. Resuscitation. doi:10.1016/j.resuscitation.2013.03.037

  21. 21.

    Guillemet L et al (2014) Acute kidney injury after out-of-hospital cardiac arrest: prevalence, risk factors and outcome. Presented at the European Society of Intensive Care Medicine (ESICM) congress, Barcelona, 27 September–1 October 2014

  22. 22.

    Cummins RO, Chamberlain D, Hazinski MF et al (1997) Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital “Utstein style”. American Heart Association. Circulation 95:2213–2239

  23. 23.

    Dumas F, Cariou A, Manzo-Silberman S et al (2010) Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: insights from the PROCAT (Parisian region out of hospital cardiac arrest) registry. Circ Cardiovasc Interv 3:200–207. doi:10.1161/CIRCINTERVENTIONS.109.913665

  24. 24.

    Chelly J, Mongardon N, Dumas F et al (2012) Benefit of an early and systematic imaging procedure after cardiac arrest: insights from the PROCAT (Parisian region out of hospital cardiac arrest) registry. Resuscitation 83:1444–1450. doi:10.1016/j.resuscitation.2012.08.321

  25. 25.

    Spaulding CM, Joly LM, Rosenberg A et al (1997) Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med 336:1629–1633. doi:10.1056/NEJM199706053362302

  26. 26.

    Mehta RL, Kellum JA, Shah SV et al (2007) Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11:R31. doi:10.1186/cc5713

  27. 27.

    Levey AS, Bosch JP, Lewis JB et al (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470

  28. 28.

    Nisula S, Kaukonen K-M, Vaara ST et al (2013) Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med 39:420–428. doi:10.1007/s00134-012-2796-5

  29. 29.

    Joannidis M, Metnitz B, Bauer P et al (2009) Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med 35:1692–1702. doi:10.1007/s00134-009-1530-4

  30. 30.

    Hasper D, von Haehling S, Storm C et al (2009) Changes in serum creatinine in the first 24 hours after cardiac arrest indicate prognosis: an observational cohort study. Crit Care 13:R168. doi:10.1186/cc8144

  31. 31.

    Vanston VJ, Lawhon-Triano M, Getts R et al (2010) Predictors of poor neurologic outcome in patients undergoing therapeutic hypothermia after cardiac arrest. South Med J 103:301–306. doi:10.1097/SMJ.0b013e3181d3cec2

  32. 32.

    Adrie C, Adib-Conquy M, Laurent I et al (2002) Successful cardiopulmonary resuscitation after cardiac arrest as a “sepsis-like” syndrome. Circulation 106:562–568

  33. 33.

    Dumas F, White L, Stubbs BA et al (2012) Long-term prognosis following resuscitation from out of hospital cardiac arrest: role of percutaneous coronary intervention and therapeutic hypothermia. J Am Coll Cardiol 60:21–27. doi:10.1016/j.jacc.2012.03.036

  34. 34.

    Tumlin J, Stacul F, Adam A et al (2006) Pathophysiology of contrast-induced nephropathy. Am J Cardiol 98:14K–20K. doi:10.1016/j.amjcard.2006.01.020

  35. 35.

    Hoste EAJ, Doom S, De Waele J et al (2011) Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis. Intensive Care Med 37:1921–1931. doi:10.1007/s00134-011-2389-8

  36. 36.

    Schetz M, Gunst J, Van den Berghe G (2014) The impact of using estimated GFR versus creatinine clearance on the evaluation of recovery from acute kidney injury in the ICU. Intensive Care Med 40:1709–1717. doi:10.1007/s00134-014-3487-1

  37. 37.

    Pickering JW, Ralib AM, Endre ZH (2013) Combining creatinine and volume kinetics identifies missed cases of acute kidney injury following cardiac arrest. Crit Care 17:R7. doi:10.1186/cc11931

Download references


GG, LG, VL, CV, and AC designed the study. GG, LG, JC, MA, VL, and WB collected the data. GG performed the statistical analysis. GG and LG wrote the manuscript. FD, VL, LL, JPM, and AC reviewed the manuscript. GG and AC take responsibility for the integrity of the work. We thank Nancy Kentish-Barnes for her help in preparing the manuscript.

Conflicts of interest


Author information

Correspondence to Alain Cariou.

Additional information

G. Geri and L. Guillemet equally contributed to this work.

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Geri, G., Guillemet, L., Dumas, F. et al. Acute kidney injury after out-of-hospital cardiac arrest: risk factors and prognosis in a large cohort. Intensive Care Med 41, 1273–1280 (2015).

Download citation


  • Acute kidney injury
  • Cardiac arrest
  • Outcome
  • Therapeutic hypothermia