Minami Kimito, Sugiyama Yoko, Iida Hiroki
Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
J Anesth. 2017 Oct;31(5):686-691. doi: 10.1007/s00540-017-2380-9. Epub 2017 Jun 21.
Acute kidney injury (AKI) has been found to be associated with short- and long-term mortality and morbidity in various clinical settings. However, it is unknown whether AKI after endovascular repair of abdominal aortic aneurysms (EVAR) is associated with postoperative mortality.
This observational study analyzed patients who underwent EVAR. The primary outcome was all-cause mortality. The outcomes of patients with and without postoperative AKI were compared using the Kaplan-Meier method and log-rank test. Factors with P < 0.05 on the univariate analysis were entered into the multivariate Cox regression model. Predictors of AKI were also determined using Cox univariate and multivariate analysis. The identified predictors of AKI were excluded from multivariate analysis for all-cause mortality because these factors could intermediate outcome.
There were 490 eligible patients. After a follow-up of 28.3 (16.8) months [mean (standard deviation)], 62 patients (12.7%) died. AKI occurred in 59 patients (12.0%). AKI was found by the log-rank test to be associated with a significant increase of all-cause mortality (P < 0.001). Preoperative estimated glomerular filtration rate, preoperative peripheral vascular disease, and emergency surgery were found to be independent predictors of AKI and these variables were excluded from the main analysis. Multivariate analysis showed AKI [hazard ratio (HR) = 1.19, 95% confidence interval (CI) 1.01-3.60, P = 0.045] and transfusion (HR = 1.05, 95% CI 1.01-1.09, P = 0.011) were independent predictors of mortality.
In the present study, AKI and transfusion were associated with significant increases in all-cause mortality after EVAR.
急性肾损伤（AKI）已被发现在各种临床环境中与短期和长期死亡率及发病率相关。然而，腹主动脉瘤腔内修复术（EVAR）后发生的AKI是否与术后死亡率相关尚不清楚。
这项观察性研究分析了接受EVAR的患者。主要结局是全因死亡率。采用Kaplan-Meier法和对数秩检验比较有和没有术后AKI患者的结局。单因素分析中P<0.05的因素被纳入多因素Cox回归模型。还使用Cox单因素和多因素分析确定AKI的预测因素。由于这些因素可能是中间结局，因此在全因死亡率的多因素分析中排除已确定的AKI预测因素。
有490例符合条件的患者。在平均（标准差）28.3（16.8）个月的随访后，62例患者（12.7%）死亡。59例患者（12.0%）发生了AKI。对数秩检验发现AKI与全因死亡率显著增加相关（P<0.001）。术前估计肾小球滤过率、术前外周血管疾病和急诊手术被发现是AKI的独立预测因素，这些变量被排除在主要分析之外。多因素分析显示AKI[风险比（HR）=1.19，95%置信区间（CI）1.01-3.60，P=0.045]和输血（HR=1.05，95%CI 1.01-1.09，P=0.011）是死亡率的独立预测因素。
在本研究中，AKI和输血与EVAR后全因死亡率的显著增加相关。
