Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea ; Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital, Hwasun-gun, Republic of Korea.
PLoS One. 2013 Dec 9;8(12):e82289. doi: 10.1371/journal.pone.0082289. eCollection 2013.
Postoperative acute kidney injury (AKI), a serious surgical complication, is common after cardiac surgery; however, reports on AKI after noncardiac surgery are limited. We sought to determine the incidence and predictive factors of AKI after gastric surgery for gastric cancer and its effects on the clinical outcomes.
We conducted a retrospective study of 4718 patients with normal renal function who underwent partial or total gastrectomy for gastric cancer between June 2002 and December 2011. Postoperative AKI was defined by serum creatinine change, as per the Kidney Disease Improving Global Outcomes guideline.
Of the 4718 patients, 679 (14.4%) developed AKI. Length of hospital stay, intensive care unit admission rates, and in-hospital mortality rate (3.5% versus 0.2%) were significantly higher in patients with AKI than in those without. AKI was also associated with requirement of renal replacement therapy. Multivariate analysis revealed that male gender; hypertension; chronic obstructive pulmonary disease; hypoalbuminemia (<4 g/dl); use of diuretics, vasopressors, and contrast agents; and packed red blood cell transfusion were independent predictors for AKI after gastric surgery. Postoperative AKI and vasopressor use entailed a high risk of 3-month mortality after multiple adjustments.
AKI was common after gastric surgery for gastric cancer and associated with adverse outcomes. We identified several factors associated with postoperative AKI; recognition of these predictive factors may help reduce the incidence of AKI after gastric surgery. Furthermore, postoperative AKI in patients with gastric cancer is an important risk factor for short-term mortality.
术后急性肾损伤（AKI）是一种严重的手术并发症，在心脏手术后很常见；然而，关于非心脏手术后 AKI 的报道有限。我们旨在确定胃癌胃切除术后 AKI 的发生率和预测因素及其对临床结局的影响。
我们对 2002 年 6 月至 2011 年 12 月期间接受部分或全胃切除术治疗胃癌且肾功能正常的 4718 例患者进行了回顾性研究。根据肾脏病改善全球结局指南，术后 AKI 定义为血清肌酐变化。
在 4718 例患者中，679 例（14.4%）发生 AKI。与无 AKI 患者相比，AKI 患者的住院时间、重症监护病房入住率和院内死亡率（3.5%比 0.2%）显著更高。AKI 还与需要肾脏替代治疗相关。多变量分析显示，男性；高血压；慢性阻塞性肺疾病；低白蛋白血症（<4 g/dl）；使用利尿剂、血管加压素和造影剂；以及输红细胞悬液是胃手术后 AKI 的独立预测因素。术后 AKI 和血管加压素的使用在多次调整后，与 3 个月死亡率的高风险相关。
胃癌胃切除术后 AKI 很常见，且与不良结局相关。我们确定了与术后 AKI 相关的几个因素；识别这些预测因素可能有助于降低胃癌胃手术后 AKI 的发生率。此外，胃癌患者术后 AKI 是短期死亡率的重要危险因素。
