Kheterpal Sachin, Tremper Kevin K, Heung Michael, Rosenberg Andrew L, Englesbe Michael, Shanks Amy M, Campbell Darrell A
Department of Anesthesiology, University of Michigan Medical School, USA.
Anesthesiology. 2009 Mar;110(3):505-15. doi: 10.1097/ALN.0b013e3181979440.
The authors sought to identify the incidence, risk factors, and mortality impact of acute kidney injury (AKI) after general surgery using a large and representative national clinical data set.
The 2005-2006 American College of Surgeons-National Surgical Quality Improvement Program participant use data file is a compilation of outcome data from general surgery procedures performed in 121 US medical centers. The primary outcome was AKI within 30 days, defined as an increase in serum creatinine of at least 2 mg/dl or acute renal failure necessitating dialysis. A variety of patient comorbidities and operative characteristics were evaluated as possible predictors of AKI. A logistic regression full model fit was used to create an AKI model and risk index. Thirty-day mortality among patients with and without AKI was compared.
Of 152,244 operations reviewed, 75,952 met the inclusion criteria, and 762 (1.0%) were complicated by AKI. The authors identified 11 independent preoperative predictors: age 56 yr or older, male sex, emergency surgery, intraperitoneal surgery, diabetes mellitus necessitating oral therapy, diabetes mellitus necessitating insulin therapy, active congestive heart failure, ascites, hypertension, mild preoperative renal insufficiency, and moderate preoperative renal insufficiency. The c statistic for a simplified risk index was 0.80 in the derivation and validation cohorts. Class V patients (six or more risk factors) had a 9% incidence of AKI. Overall, patients experiencing AKI had an eightfold increase in 30-day mortality.
Approximately 1% of general surgery cases are complicated by AKI. The authors have developed a robust risk index based on easily identified preoperative comorbidities and patient characteristics.
作者试图利用一个大型且具有代表性的全国临床数据集，确定普通外科手术后急性肾损伤（AKI）的发生率、危险因素及对死亡率的影响。
2005 - 2006年美国外科医师学会-国家外科质量改进计划参与者使用的数据文件，是美国121家医疗中心进行的普通外科手术结局数据的汇总。主要结局是30天内发生的AKI，定义为血清肌酐至少升高2mg/dl或因急性肾衰竭需要透析。评估了多种患者合并症和手术特征作为AKI的可能预测因素。使用逻辑回归全模型拟合创建AKI模型和风险指数。比较了发生AKI和未发生AKI患者的30天死亡率。
在审查的152,244例手术中，75,952例符合纳入标准，762例（1.0%）发生AKI并发症。作者确定了11个独立的术前预测因素：年龄56岁及以上、男性、急诊手术、腹腔内手术、需要口服治疗的糖尿病、需要胰岛素治疗的糖尿病、活动性充血性心力衰竭、腹水、高血压、轻度术前肾功能不全和中度术前肾功能不全。简化风险指数在推导队列和验证队列中的c统计量为0.80。V级患者（六个或更多风险因素）的AKI发生率为9%。总体而言，发生AKI的患者30天死亡率增加了八倍。
约1%的普通外科病例并发AKI。作者基于易于识别的术前合并症和患者特征开发了一个强大的风险指数。
