Perioperative medicine & outcomes
Preoperative estimated glomerular filtration rate to predict cardiac events in major noncardiac surgery: a secondary analysis of two large international studies
Authors' conclusion
Continuous preoperative eGFR is among the best cardiac risk predictors in noncardiac surgery of the large set examined.
Study context
- Population
- Patients ≥45 yr undergoing nonurgent inpatient noncardiac surgery
- Participants
- 35,815 vs 9,219
- Comparison
- Preoperative estimated glomerular filtration rate (eGFR) and cardiac events, by age and sex
- VISIONn = 35,815
- POISE-2n = 9,219
- Primary endpoint
- Composite of:
- MINS
- Nonfatal cardiac arrest
- Cardiac death
- Follow-up
- 30 days after surgery
Methodological detailsprognostic modelling, international
- Prognostic modelling
- International
Primary result
As reported in the abstract
Primary composite; association with lower preoperative eGFR · 30 days
Relative risk (95% CI)
eGFR 30 vs 90 ml min-1 1.73 m-2, age 80 yr, female, VISION
1.49(1.26–1.78)
eGFR 30 vs 90 ml min-1 1.73 m-2, age 50 yr, female, VISION
4.50(2.84–7.13)
- Strong, graded association of cardiac events with lower eGFR, attenuated by older age (interaction P, VISION)
- P for interaction < 0.001
- Strong, graded association of cardiac events with lower eGFR, attenuated by older age (interaction P, POISE-2)
- P for interaction = 0.008
Further findings
Sex interaction (men vs women)
- Differed modestly (not meaningfully) in men in VISION
- P for interaction = 0.02
- No difference by sex in POISE-2
- P for interaction = 0.79
Predictive contribution of eGFR vs other predictors
- eGFR contributed most predictive information and mean net benefit of all predictors in both studies; most C-statistic in VISION, third most in POISE-2
Original publication
Preoperative estimated glomerular filtration rate to predict cardiac events in major noncardiac surgery: a secondary analysis of two large international studies. Br J Anaesth. Published 2 January 2025. doi:10.
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