From the Department of Anesthesiology.
Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan.
Anesth Analg. 2018 Nov;127(5):1229-1235. doi: 10.1213/ANE.0000000000003576.
Acute kidney injury (AKI) occurs in 6.1%-22.4% of patients undergoing major noncardiac surgery. Previous studies have shown no association between intraoperative urine output and postoperative acute renal failure. However, these studies used various definitions of acute renal failure. We therefore investigated the association between intraoperative oliguria and postoperative AKI defined by the serum creatinine criteria of the Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) classification.
In this single-center, retrospective, observational study, we screened 26,984 patients undergoing elective or emergency surgery during the period September 1, 2008 to October 31, 2011 at a university hospital. Exclusion criteria were age <18 years; duration of anesthesia <120 minutes; hospital stay <2 nights; local anesthesia only; urologic or cardiac surgery; coexisting end-stage kidney disease; and absence of serum creatinine measurement, intraoperative urine output data, or information regarding intraoperative drug use. Multivariable logistic regression analysis was used as the primary analytic method.
A total of 5894 patients were analyzed. The incidence of postoperative AKI was 7.3%. By multivariable analysis, ≥120 minutes of oliguria (odds ratio = 2.104, 95% CI, 1.593-2.778; P < .001) was independently associated with the development of postoperative AKI. After propensity-score matching of patients with ≥120 and <120 minutes of oliguria on baseline characteristics, the incidence of AKI in patients with ≥120 minutes of oliguria (n = 827; 10%) was significantly greater than that in those with <120 minutes of oliguria (n = 827; 4.8%; odds ratio = 2.195, 95% CI, 1.806-2.668; P < .001).
Contrary to previous studies, we found that intraoperative oliguria is associated with the incidence of AKI after major noncardiac surgery.
急性肾损伤（AKI）发生在 6.1%-22.4%接受非心脏大手术的患者中。先前的研究表明术中尿量与术后急性肾衰竭之间没有关联。然而，这些研究使用了不同的急性肾衰竭定义。因此，我们调查了根据风险、损伤、衰竭、丧失和终末期肾病（RIFLE）分类的血清肌酐标准定义的术中少尿与术后 AKI 之间的关联。
在这项单中心、回顾性、观察性研究中，我们筛选了 2008 年 9 月 1 日至 2011 年 10 月 31 日期间在一家大学医院接受择期或紧急手术的 26984 名患者。排除标准为年龄<18 岁；麻醉持续时间<120 分钟；住院时间<2 晚；局部麻醉；泌尿科或心脏手术；并存终末期肾病；以及缺乏血清肌酐测量、术中尿量数据或术中用药信息。多变量逻辑回归分析是主要分析方法。
共分析了 5894 名患者。术后 AKI 的发生率为 7.3%。通过多变量分析，≥120 分钟的少尿（比值比=2.104，95%CI，1.593-2.778；P<0.001）与术后 AKI 的发生独立相关。在对基础特征上≥120 分钟和<120 分钟少尿的患者进行倾向评分匹配后，≥120 分钟少尿的患者（n=827；10%）的 AKI 发生率明显高于<120 分钟少尿的患者（n=827；4.8%；比值比=2.195，95%CI，1.806-2.668；P<0.001）。
与先前的研究相反，我们发现术中少尿与非心脏大手术后 AKI 的发生率相关。
