Perioperative medicine & outcomes
Dose-response association between intraoperative norepinephrine and postoperative acute kidney injury: a retrospective cohort study
Authors' conclusion
Intraoperative norepinephrine exposure was independently associated with postoperative AKI, with nonlinear behaviour for unit-rate metrics and linear behaviour for time-integrated metrics, largely independent of intraoperative hypotension.
Study context
- Population
- Surgical cases from the Medical Informatics Operating Room Vitals and Events Repository1,232 (4.4%) received norepinephrine
- Participants
- 27,874 cases
- Exposure
- Intraoperative norepinephrine dose and postoperative acute kidney injury (AKI)
- Outcome
- AKI
- Follow-up
- Within 7 postoperative days
Methodological detailsrestricted cubic splines, tensor-product generalised additive models, multivariable mixed-effects logistic regression, directed acyclic graph-derived adjustment set
- Restricted cubic splines
- Tensor-product generalised additive models
- Multivariable mixed-effects logistic regression
- Directed acyclic graph-derived adjustment set
Main finding
As reported in the abstract
AKI within 7 postoperative days
Maximum norepinephrine dose >0.029 μg kg-1 min-1Estimate (95% CI)P value
AKI within 7 postoperative days
OR 1.76(1.41–2.20)
P < 0.001Adjusted for intraoperative hypotension; association attenuated 5.1%
adjusted OR 1.71(1.36–2.15)
- Nonlinearity, maximum dose
- P = 0.008
- Nonlinearity, time-weighted intensity
- P = 0.022
- Linearity, AUC
- P = 0.10
- Linearity, duration
- P = 0.50
- Bedside-readable anchors for maximum norepinephrine dose (μg kg-1 min-1)
- 0.029 and 0.064
Observational data: associations, not effects.
Further findings
- Dose-duration interaction non-significant
- P = 0.286
- Dose-hypotension interaction non-significant
- P = 0.298
- Interaction P; supporting additive effects
Original publication
Dose-response association between intraoperative norepinephrine and postoperative acute kidney injury: a retrospective cohort study. Br J Anaesth. Published 31 July 2026. doi:10.
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