An Observational Study of Changes in Renin Concentrations and Associations With Complications Following Cardiac Surgery.

Abstract

Increased plasma renin concentrations have been reported in patients following cardiac surgery while correlations to clinical outcomes have varied. More evidence is needed to support the potential clinical utility of plasma renin as a biomarker guiding postoperative management, including the need for alternative pharmacotherapy when standard catecholaminergic cardiovascular support is insufficient. Plasma concentrations were determined by direct renin immunoassay (milli-International Units per litre, mIU L^-1) on admission to ICU and then six and 24 h later. Postoperative complications were assessed by the composite and separate incidence of acute kidney injury, acute myocardial infarction, shock, acute respiratory failure, new onset atrial flutter/fibrillation and cerebrovascular accident. Pharmacological support required to treat postoperative haemodynamic instability was quantified using the vasoactive-inotropic score. One hundred and four patients were studied and 54 (52%) met at least one diagnostic criterion for postoperative complications. Renin concentrations on admission (130 [34-445] mIU L^-1) and six (119 [35-447] mIU L^-1) and 24 h later (184 [54-513] mIU L^-1) were not significantly different with substantial inter-individual variation. Cumulative renin concentrations over 24 h were higher in haemodynamically unstable patients (median difference 1296 [54-2943] mIU L^-1, p = 0.04) and in patients with any postoperative complication (median difference 1887 [908-6177] mIU L^-1, p = 0.04). Plasma renin increased by 11 mIU L^-1 for each unit increase in the vasoactive-inotropic score. A statistical model using all renin measurements predicted haemodynamic instability (AUC 0.77 [0.55-0.95], p = 0.04) and shock (AUC 0.95 [0.83-1.0], p = < 0.001), but not the composite or separate incidence of the other complications. Haemodynamic compromise, but not postoperative complications overall, were associated with serial plasma renin concentrations during the first 24 h of ICU admission following cardiac surgery. Additional prospective studies are warranted to elucidate the relationship between renin dynamics, postoperative complications and criteria for escalating vasopressor therapy. This prospective observational study tested whether postoperative increase in plasma renin in patients undergoing cardiac surgery was associated with postoperative complications. No such association was found, but an association between increase in plasma renin and haemodynamic compromise and need for pharmacological support was found. Larger studies are warranted to elucidate the role of plasma renin as a biomarker for postoperative complications. ClinicalTrials.gov identifier: NCT043303455.