Effect of a Perioperative Hypotension Avoidance Strategy vs. a Hypertension Avoidance Strategy on the Risk of AKI
Bibliographic record
Abstract
Background: Acute kidney injury (AKI) is a common complication of the over 200 million noncardiac surgeries performed worldwide each year. We conducted a pre-specified substudy of the POISE-3 trial to determine whether a peri-operative hypotension-avoidance strategy versus a hypertension-avoidance strategy alters the risk of postoperative AKI (substudy protocol publication: PMID 35024154). Methods: This was a two-group, open-label, randomized trial of 7307 high-risk patients from 110 hospitals in 22 countries undergoing noncardiac surgery. Patients were ≥ 45 years old and took at least one antihypertensive medication. hypotension-avoidance strategy ... target intraopertive mean arterial pressure (MAP) ≥80 mmHg ... on day of surgery and for 2 days after, aim to hold renin-angiotensin-aldosterone system inhibitors ... stepwise use other long-term antihypertensive medications if SBP ≥130 mmHg hypertension-avoidance strategy ... target intraoperative MAP ≥60 mmHg ... continue all antihypertensive medications before and after surgery. The primary outcome was postoperative AKI, defined as an increase in serum creatinine concentration of either ≥26.5 μmol/L (≥0.3 mg/dL) within 48 hours of randomization or ≥50% within 7 days of randomization. Results: The hypotension-avoidance group (n=3654) vs. the hypertension-avoidance group (n=3653), ... used fewer antihypertensive medications ...........specifically, 6% vs. 38% of patients used an ACEi or ARB on the day of surgery, ..............................6% vs. 47% one day after surgery, ............................. 7% vs. 50% two days after surgery. ... spent less intraoperative time with a MAP < 80 mmHg (average 28% vs. 45% of the time) ... had no difference in mean SBP/DBP/MAP outside the operation (day of surgery and two days after surgery) ... had no difference in the risk of AKI ........... (15.1% vs. 14.4%; relative risk 1.05 [95% CI, 0.93 to 1.19]). Results were consistent with multiple alternate continuous and categorical definitions of AKI and in the subgroup with baseline chronic kidney disease. Conclusion: In this trial of patients undergoing noncardiac surgery, the risk of postoperative AKI did not differ between patients randomized to receive a hypotension-avoidance strategy versus a hypertension-avoidance strategy.. Trial registration: NCT03505723. Funding: Private Foundation Support, Government Support - Non-U.S.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".