Kovacheva Vesela P, Aglio Linda S, Boland Torrey A, Mendu Mallika L, Gibbons Fiona K, Christopher Kenneth B
‡Brigham and Women's Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts; §Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois; ¶Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; ‖Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; #The Nathan E. Hellman Memorial Laboratory, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Neurosurgery. 2016 Sep;79(3):389-96. doi: 10.1227/NEU.0000000000001153.
Acute kidney injury (AKI) is a serious postoperative complication.
To determine whether AKI in patients after craniotomy is associated with heightened 30-day mortality.
We performed a 2-center, retrospective cohort study of 1656 craniotomy patients who received critical care between 1998 and 2011. The exposure of interest was AKI defined as meeting RIFLE (Risk, Injury, Failure, Loss of Kidney Function, and End-stage Kidney Disease) class risk, injury, and failure criteria, and the primary outcome was 30-day mortality. Adjusted odds ratios were estimated by multivariable logistic regression models with inclusion of covariate terms thought to plausibly interact with both AKI and mortality. Additionally, mortality in craniotomy patients with AKI was analyzed with a risk-adjusted Cox proportional hazards regression model and propensity score matching as a sensitivity analysis.
The incidences of RIFLE class risk, injury, and failure were 5.7%, 2.9%, and 1.3%, respectively. The odds of 30-day mortality in patients with RIFLE class risk, injury, or failure fully adjusted were 2.79 (95% confidence interval [CI], 1.76-4.42), 7.65 (95% CI, 4.16-14.07), and 14.41 (95% CI, 5.51-37.64), respectively. Patients with AKI experienced a significantly higher risk of death during follow-up; hazard ratio, 1.82 (95% CI, 1.34-2.46), 3.37 (95% CI, 2.36-4.81), and 5.06 (95% CI, 2.99-8.58), respectively, fully adjusted. In a cohort of propensity score-matched patients, RIFLE class remained a significant predictor of 30-day mortality.
Craniotomy patients who suffer postoperative AKI are among a high-risk group for mortality. The severity of AKI after craniotomy is predictive of 30-day mortality.
AKI, acute kidney injuryAPACHE II, Acute Physiology and Chronic Health Evaluation IICI, confidence intervalCPT, Current Procedural TerminologyICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical ModificationRIFLE, risk, injury, failure, loss of kidney function, and end-stage kidney diseaseRPDR, Research Patient Data Registry.
急性肾损伤（AKI）是一种严重的术后并发症。
确定开颅术后患者的AKI是否与30天死亡率升高相关。
我们对1998年至2011年间接受重症监护的1656例开颅手术患者进行了一项双中心回顾性队列研究。感兴趣的暴露因素是定义为符合RIFLE（风险、损伤、衰竭、肾功能丧失和终末期肾病）分级的风险、损伤和衰竭标准的AKI，主要结局是30天死亡率。通过多变量逻辑回归模型估计调整后的优势比，模型中纳入了被认为可能与AKI和死亡率均相互作用的协变量项。此外，使用风险调整的Cox比例风险回归模型和倾向得分匹配对发生AKI的开颅手术患者的死亡率进行分析，作为敏感性分析。
RIFLE分级的风险、损伤和衰竭的发生率分别为5.7%、2.9%和1.3%。RIFLE分级为风险、损伤或衰竭的患者经充分调整后的30天死亡优势比分别为2.79（95%置信区间[CI]，1.76 - 4.42）、7.65（95%CI，4.16 - 14.07）和14.41（95%CI，5.51 - 37.64）。发生AKI的患者在随访期间死亡风险显著更高；经充分调整后的风险比分别为1.82（95%CI，1.34 - 2.46）、3.37（95%CI，2.36 - 4.81）和5.06（95%CI，2.99 - 8.58）。在倾向得分匹配患者队列中，RIFLE分级仍然是30天死亡率的显著预测因素。
术后发生AKI的开颅手术患者属于高死亡风险组。开颅术后AKI的严重程度可预测30天死亡率。
AKI，急性肾损伤；APACHE II，急性生理与慢性健康状况评估II；CI，置信区间；CPT，当前手术操作术语；ICD - 9 - CM，国际疾病分类第九版临床修订本；RIFLE，风险、损伤、衰竭、肾功能丧失和终末期肾病；RPDR，研究患者数据登记库
