腹部手术后的急性肾损伤：发病率、危险因素及结局

Acute Kidney Injury After Abdominal Surgery: Incidence, Risk Factors, and Outcome.

作者信息

Long Thorir E, Helgason Dadi, Helgadottir Solveig, Palsson Runolfur, Gudbjartsson Tomas, Sigurdsson Gisli H, Indridason Olafur S, Sigurdsson Martin I

机构信息

From the *Internal Medicine, †Surgical, and ‡Perioperative Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; §Faculty of Medicine, University of Iceland, Reykjavik, Iceland; and ‖Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

出版信息

Anesth Analg. 2016 Jun;122(6):1912-20. doi: 10.1213/ANE.0000000000001323.

DOI:10.1213/ANE.0000000000001323

PMID:27195635

Abstract

BACKGROUND

Acute kidney injury (AKI) is a serious complication after major surgical procedures. We examined the incidence, risk factors, and mortality of patients who sustained AKI after abdominal surgery in a large population-based cohort.

METHODS

All patients who underwent open and laparoscopic abdominal surgery (excluding genitourinary and abdominal vascular procedures), between 2007 and 2014 at the University Hospital in Reykjavik were identified and their perioperative serum creatinine (SCr) measurements used to identify AKI after surgery employing the Kidney Disease: Improving Global Outcome (KDIGO) criteria. Risk factors were evaluated using multivariate logistic regression analysis and 30-day mortality compared with a propensity score-matched control group.

RESULTS

During the 8-year period, a total of 11,552 abdominal surgeries were performed on 10,022 patients. Both pre- and postoperative SCr measurements were available for 3902 (33.8%) of the surgical cases. Of these, 264 (6.8%) were complicated by AKI; 172 (4.4%), 49 (1.3%), and 43 (1.1%) were classified as KDIGO stages 1, 2 and 3, respectively. The overall incidence of AKI for patients with available SCr values was 67.7 (99% confidence interval [CI], 57.7-78.6) per 1000 surgeries. In logistic regression analysis, independent risk factors for AKI were female sex (odds ratio [OR] = 0.68; 99% CI, 0.47-0.98), hypertension (OR = 1.75; 99% CI, 1.10-2.74), preoperative chronic kidney disease (OR= 1.68; 99% CI, 1.12-2.50), ASA physical status classification of IV (OR = 9.48; 99% CI, 3.66-29.2) or V (OR = 21.4; 99% CI, 5.28-93.6), and reoperation (OR = 4.30; 99% CI, 2.36-7.70). Patients with AKI had greater 30-day mortality (18.2% vs 5.3%; P < 0.001) compared with propensity score-matched controls.

CONCLUSIONS

AKI is an important complication of abdominal surgery. In addition to sex, hypertension, and chronic kidney disease, ASA physical status classification is an independent predictor of AKI. Individuals who develop AKI have substantially worse short-term outcomes, including higher 30-day mortality, even after correcting for multiple patient- and procedure-related risk factors.

摘要

背景

急性肾损伤（AKI）是 major surgical procedures 后的一种严重并发症。我们在一个基于人群的大型队列中研究了腹部手术后发生 AKI 的患者的发病率、危险因素及死亡率。

方法

确定了 2007 年至 2014 年期间在雷克雅未克大学医院接受开放和腹腔镜腹部手术（不包括泌尿生殖系统和腹部血管手术）的所有患者，并使用他们围手术期的血清肌酐（SCr）测量值，采用肾脏病：改善全球预后（KDIGO）标准来识别术后的 AKI。使用多因素逻辑回归分析评估危险因素，并将 30 天死亡率与倾向评分匹配的对照组进行比较。

结果

在这 8 年期间，对 10022 名患者共进行了 11552 例腹部手术。3902 例（33.8%）手术病例有术前和术后的 SCr 测量值。其中，264 例（6.8%）并发 AKI；172 例（4.4%）、49 例（1.3%）和 43 例（1.1%）分别被分类为 KDIGO 1、2 和 3 期。有可用 SCr 值的患者中 AKI 的总体发病率为每 1000 例手术 67.7 例（99%置信区间[CI]，）。在逻辑回归分析中，AKI 的独立危险因素为女性（比值比[OR]=0.68；99%CI，0.47 - 0.98）、高血压（OR = 1.75；99%CI，1.10 - 2.74）、术前慢性肾脏病（OR = 1.68；99%CI，1.12 - 2.50）、ASA 身体状况分类为 IV（OR = 9.48；99%CI，3.66 - 29.2）或 V（OR = 21.4；99%CI，5.28 - 93.6）以及再次手术（OR = 4.30；99%CI，2.36 - 7.70）。与倾向评分匹配的对照组相比，AKI 患者的 30 天死亡率更高（18.2%对 5.3%；P < 0.001）。