Abelha Fernando José, Botelho Miguela, Fernandes Vera, Barros Henrique
Department of Anesthesiology, Hospital de São João, Alameda Professor Hernani Monteiro, Porto 4202-451, Portugal.
Crit Care. 2009;13(3):R79. doi: 10.1186/cc7894. Epub 2009 May 22.
Development of acute kidney injury (AKI) during the perioperative period is associated with increases in morbidity and mortality. Our aim was to evaluate the incidence and determinants of postoperative AKI after major noncardiac surgery in patients with previously normal renal function.
This retrospective cohort study was carried out in the multidisciplinary Post-Anaesthesia Care Unit (PACU) with five intensive care beds. The study population consisted of 1166 patients with no previous renal insufficiency who were admitted to these intensive care unit (ICU) beds over 2 years. After admission patients were followed for the development of AKI, defined as proposed by The Acute Kidney Injury Network (increment of serum creatinine [greater than or equal to] 0.3 mg/dL or 50% from baseline within 48 hours or urine output < 0.5 mL/kg/hr for > 6 hours despite fluid resuscitation when applicable). Patient preoperative characteristics, intraoperative management and outcome were evaluated for associations with acute kidney injury using an univariate and multiple logistic regression model.
A total of 1597 patients were admitted to the PACU and of these, 1166 met the inclusion criteria. Eighty-seven patients (7.5%) met AKI criteria. Univariate analysis identified age, American Society of Anesthesiologists (ASA) physical status, emergency surgery, high risk surgery, ischemic heart disease, congestive heart disease and Revised Cardiac Risk Index (RCRI) score as independent preoperative determinants for AKI in the postoperative period. Multivariate analysis identified ASA physical status, RCRI score, high risk surgery and congestive heart disease as preoperative determinants for AKI in the postoperative period. Patients that developed AKI had higher Simplified Acute Physiology Score (SAPS) II and Acute Physiology and Chronic Health Evaluation (APACHE) II, higher PACU length of stay (LOS), higher PACU mortality, higher hospital mortality and higher mortality at 6 months follow-up. AKI was an independent risk factor for hospital mortality (OR 3.12, 95% CI 1.41 to 6.93, P = 0.005).
This study shows that age, emergency and high risk surgery, ischemic heart disease, congestive heart disease, ASA physical status and RCRI score were considered risk factors for the development of AKI, in patients needing intensive care after surgery. AKI has serious impact on PACU length of stay and mortality. AKI was an independent risk factor for hospital mortality.
围手术期急性肾损伤（AKI）的发生与发病率和死亡率的增加相关。我们的目的是评估术前肾功能正常的患者在接受非心脏大手术后发生术后AKI的发生率及其决定因素。
这项回顾性队列研究在设有五张重症监护床位的多学科麻醉后护理单元（PACU）中进行。研究人群包括2年内入住这些重症监护病房（ICU）床位的1166例既往无肾功能不全的患者。患者入院后随访AKI的发生情况，AKI的定义采用急性肾损伤网络的标准（血清肌酐升高[大于或等于]0.3mg/dL或较基线水平在48小时内升高50%，或在适当进行液体复苏的情况下尿量<0.5mL/kg/hr持续超过6小时）。采用单因素和多因素逻辑回归模型评估患者术前特征、术中管理及预后与急性肾损伤的相关性。
共有1597例患者入住PACU，其中1166例符合纳入标准。87例患者（7.5%）符合AKI标准。单因素分析确定年龄、美国麻醉医师协会（ASA）身体状况、急诊手术、高风险手术、缺血性心脏病、充血性心脏病和修订心脏风险指数（RCRI）评分是术后AKI的独立术前决定因素。多因素分析确定ASA身体状况、RCRI评分、高风险手术和充血性心脏病是术后AKI的术前决定因素。发生AKI的患者简化急性生理学评分（SAPS）II和急性生理学与慢性健康状况评估（APACHE）II更高，PACU住院时间（LOS）更长，PACU死亡率更高，医院死亡率更高，6个月随访时死亡率也更高。AKI是医院死亡的独立危险因素（比值比3.12，95%可信区间1.41至6.93，P=0.005）。
本研究表明，年龄、急诊和高风险手术、缺血性心脏病、充血性心脏病、ASA身体状况和RCRI评分是术后需要重症监护的患者发生AKI的危险因素。AKI对PACU住院时间和死亡率有严重影响。AKI是医院死亡的独立危险因素。
