Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Hepatobiliary Pancreat Dis Int. 2010 Jun;9(3):259-63.
Acute kidney injury (AKI) is a common complication in the early period after liver transplantation (LT), posing an enormous obstacle to treatment efficiency and patient survival. However, the exact influencing factors of AKI are still unclear and a predictive model is desperately required in the clinic.
Data of 102 consecutive LTs were reviewed. A model for predicting AKI was established and further validated in a prospective study of 44 patients receiving LT.
The incidence of AKI was 32.4%. AKI patients showed a significantly lower survival rate than non-AKI patients. Multivariate analysis demonstrated the independent influencing factors of AKI were preoperative serum creatinine >1.2 mg/dl, intraoperative urine output <or=60 ml/h, intraoperative hypotension status, and intraoperative use of noradrenaline. A model was then established and showed a sensitivity of 75.0%, a specificity of 93.8%, and an accuracy of 88.6% in predicting AKI.
High preoperative serum creatinine, low intraoperative urine output, and intraoperative hypotension contribute to the development of AKI, and intraoperative use of noradrenaline serves as a protective factor. The predictive model could potentially facilitate early prediction and surveillance of AKI.
急性肾损伤（AKI）是肝移植（LT）后早期的常见并发症，对治疗效果和患者生存构成巨大障碍。然而，AKI的确切影响因素仍不清楚，临床上迫切需要预测模型。
回顾了 102 例连续 LT 的数据。建立了预测 AKI 的模型，并在 44 例接受 LT 的前瞻性研究中进一步验证。
AKI 的发生率为 32.4%。AKI 患者的生存率明显低于非 AKI 患者。多变量分析表明，术前血清肌酐>1.2mg/dl、术中尿量<或=60ml/h、术中低血压状态和术中使用去甲肾上腺素是 AKI 的独立影响因素。然后建立了一个模型，该模型在预测 AKI 时的灵敏度为 75.0%，特异性为 93.8%，准确性为 88.6%。
术前血清肌酐升高、术中尿量减少和术中低血压导致 AKI 的发生，术中使用去甲肾上腺素是保护因素。该预测模型可能有助于早期预测和监测 AKI。
