Marouli Diamantina, Stylianou Kostas, Papadakis Eleftherios, Kroustalakis Nikolaos, Kolyvaki Stavroula, Papadopoulos Georgios, Ioannou Christos, Papaioannou Alexandra, Daphnis Eugene, Georgopoulos Dimitris, Askitopoulou Helen
Departments of Anaesthesiology, University Hospital of Heraklion, 71110 Crete, Greece.
Intensive Care, University Hospital of Heraklion, 71110 Crete, Greece.
J Clin Med. 2018 Nov 9;7(11):431. doi: 10.3390/jcm7110431.
Postoperative Acute Kidney Injury (AKI) is a common and serious complication associated with significant morbidity and mortality. While several pre- and intra-operative risk factors for AKI have been recognized in cardiac surgery patients, relatively few data are available regarding the incidence and risk factors for perioperative AKI in other surgical operations. The aim of the present study was to determine the risk factors for perioperative AKI in patients undergoing major abdominal surgery.
This was a prospective, observational study of patients undergoing major abdominal surgery in a tertiary care center. Postoperative AKI was diagnosed according to the Acute Kidney Injury Network criteria within 48 h after surgery. Patients with chronic kidney disease stage IV or V were excluded. Logistic regression analysis was used to evaluate the association between perioperative factors and the risk of developing postoperative AKI.
Eleven out of 61 patients developed postoperative AKI. Four intra-operative variables were identified as predictors of AKI: intra-operative blood loss ( = 0.002), transfusion of fresh frozen plasma ( = 0.004) and red blood cells ( = 0.038), as well as high chloride load ( = 0.033, cut-off value > 500 mEq). Multivariate analysis demonstrated an independent association between AKI development and preoperative albuminuria, defined as a urinary Albumin to Creatinine ratio ≥ 30 mg·g (OR = 6.88, 95% CI: 1.43⁻33.04, = 0.016) as well as perioperative chloride load > 500 mEq (OR = 6.87, 95% CI: 1.46⁻32.4, = 0.015).
Preoperative albuminuria, as well as a high intraoperative chloride load, were identified as predictors of postoperative AKI in patients undergoing major abdominal surgery.
术后急性肾损伤（AKI）是一种常见且严重的并发症，与显著的发病率和死亡率相关。虽然心脏手术患者中已识别出一些术前和术中的AKI危险因素，但关于其他外科手术围手术期AKI的发病率和危险因素的数据相对较少。本研究的目的是确定接受大型腹部手术患者围手术期AKI的危险因素。
这是一项在三级医疗中心对接受大型腹部手术患者进行的前瞻性观察研究。术后AKI根据急性肾损伤网络标准在术后48小时内诊断。排除慢性肾脏病IV期或V期患者。采用逻辑回归分析评估围手术期因素与发生术后AKI风险之间的关联。
61例患者中有11例发生术后AKI。四个术中变量被确定为AKI的预测因素：术中失血（P = 0.002）、输注新鲜冰冻血浆（P = 0.004）和红细胞（P = 0.038），以及高氯负荷（P = 0.033，临界值> 500 mEq）。多变量分析显示AKI发生与术前白蛋白尿之间存在独立关联，术前白蛋白尿定义为尿白蛋白与肌酐比值≥ 30 mg·g（OR = 6.88，95% CI：1.43⁻33.04，P = 0.016）以及围手术期氯负荷> 500 mEq（OR = 6.87，95% CI：1.46⁻32.4，P = 0.015）。
术前白蛋白尿以及术中高氯负荷被确定为接受大型腹部手术患者术后AKI的预测因素。
