Department of Anesthesiology, University of Virginia, Charlottesville, Virginia.
J Neurosurg Spine. 2014 May;20(5):505-11. doi: 10.3171/2014.2.SPINE13596. Epub 2014 Mar 21.
Earlier definitions of acute renal failure are not sensitive in identifying milder forms of acute kidney injury (AKI). The authors hypothesized that by applying the RIFLE criteria for acute renal failure (Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage kidney disease) to thoracic and lumbar spine surgery, there would be a higher incidence of AKI. They also developed a model to predict the postoperative glomerular filtration rate (GFR).
A hospital data repository was used to identify patients undergoing thoracic and/or lumbar spine surgery over a 5-year period (2006-2011). The lowest GFR in the first week after surgery was used to identify and categorize kidney injury if present. Risk factors were identified and a model was developed to predict postoperative GFR based on the defined risk factors.
A total of 726 patients were identified over the study period. The incidence of AKI was 3.9% (n = 28) based on the RIFLE classification with 23 patients in the risk category and 5 in the injury category. No patient was classified into the failure category or required renal replacement therapy. The baseline GFR in the non-AKI and AKI groups was 80 and 79.8 ml/min, respectively. After univariate analysis, only hypertension was associated with postoperative AKI (p = 0.02). A model was developed to predict the postoperative GFR. This model accounted for 64.4% of the variation in the postoperative GFRs (r(2) = 0.644).
The incidence of AKI in spine surgery is higher than previously reported, with all of the patients classified into either the risk or injury RIFLE categories. Because these categories have previously been shown to be associated with poor long-term outcomes, early recognition, management, and follow-up of these patients is important.
先前的急性肾衰竭定义并不敏感，无法识别更轻微形式的急性肾损伤（AKI）。作者假设，通过将急性肾衰竭的 RIFLE 标准（肾功能障碍风险、肾损伤、肾功能衰竭、肾功能丧失和终末期肾病）应用于胸腰椎手术，AKI 的发生率会更高。他们还开发了一种预测术后肾小球滤过率（GFR）的模型。
使用医院数据存储库来确定在 5 年期间（2006-2011 年）接受胸腰椎手术的患者。如果存在肾损伤，则使用术后第一周的最低 GFR 来识别和分类。确定危险因素，并根据定义的危险因素开发预测术后 GFR 的模型。
在研究期间共确定了 726 例患者。根据 RIFLE 分类，AKI 的发生率为 3.9%（n=28），其中风险类别 23 例，损伤类别 5 例。没有患者被归类为衰竭类别或需要肾脏替代治疗。非 AKI 和 AKI 组的基线 GFR 分别为 80 和 79.8ml/min。单因素分析后，只有高血压与术后 AKI 相关（p=0.02）。开发了一个预测术后 GFR 的模型。该模型可以解释术后 GFR 变化的 64.4%（r²=0.644）。
脊柱手术后 AKI 的发生率高于先前报道，所有患者均被归类为风险或损伤 RIFLE 类别。由于这些类别先前已被证明与不良长期预后相关，因此早期识别、管理和随访这些患者非常重要。
