UCD School of Medicine and Medical Science, Consultant in Nephrology and Clinical Pharmacology, Mater Misericordiae University Hospital, Nelson Street, Dublin 7, Ireland.
Crit Care. 2009;13(4):171. doi: 10.1186/cc7942. Epub 2009 Jul 30.
Abelha and colleagues evaluated the incidence and determinants of postoperative acute kidney injury (AKI) after major noncardiac surgery in patients with previously normal renal function. In this retrospective study of 1,166 patients with no previous renal insufficiency, who were admitted to a postsurgical intensive care unit (ICU) over a 2-year period, the incidence of AKI was 7.5%. Multivariate analysis identified American Society of Anesthesiologists physical status, Revised Cardiac Risk Index, high-risk surgery and congestive heart disease as preoperative AKI risk factors. AKI was an independent risk factor for hospital mortality (odds ratio = 3.12, 95% confidence interval = 1.41 to 6.93; P = 0.005), and was associated with higher severity of illness scores (Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation II), longer ICU length of stay, higher ICU mortality, increased hospital mortality and higher mortality at 6-month follow up. Although the study design excluded 121 patients with significant preoperative renal insufficiency by design, the relatively crude serum creatinine cut-offs used certainly permitted inclusion of numerous patients with preoperative renal impairment. Accordingly, the study design failed to quantify the impact of preoperative renal impairment on risk and outcomes of perioperative AKI in noncardiac surgery, and this should be a goal of such studies in the future. Nonetheless, the study is an important addition to the literature in an under-studied population of patients at high risk for AKI.
阿贝尔哈等人评估了肾功能正常的患者在接受非心脏大手术后发生术后急性肾损伤（AKI）的发生率和决定因素。在这项对 1166 名无先前肾功能不全的患者进行的回顾性研究中，这些患者在 2 年内入住术后重症监护病房（ICU），AKI 的发生率为 7.5%。多变量分析确定美国麻醉医师协会身体状况、修订后的心脏风险指数、高危手术和充血性心力衰竭是术前 AKI 的危险因素。AKI 是医院死亡率的独立危险因素（比值比=3.12，95%置信区间=1.41 至 6.93；P=0.005），并与更严重的疾病评分（简化急性生理学评分 II 和急性生理学和慢性健康评估 II）、更长的 ICU 住院时间、更高的 ICU 死亡率、增加的医院死亡率和 6 个月随访时的更高死亡率相关。尽管研究设计排除了 121 名术前有明显肾功能不全的患者，但相对粗糙的血清肌酐截止值肯定允许包括许多术前有肾功能损害的患者。因此，该研究设计未能量化术前肾功能不全对非心脏手术围手术期 AKI 风险和结果的影响，这应该是未来此类研究的目标。尽管如此，该研究还是对高危 AKI 患者这一研究较少的人群的文献做出了重要补充。
