Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan.
Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan.
J Crit Care. 2019 Apr;50:17-22. doi: 10.1016/j.jcrc.2018.11.008. Epub 2018 Nov 13.
We conducted a retrospective cohort study to determine incidences of transient and persistent acute kidney injury (AKI) after major abdominal surgery and their impacts on long-term outcome.
We enrolled 3751 patients undergoing major abdominal surgery. Postoperative AKI was classified as transient or persistent based on the return of serum creatinine to the non-AKI range within 7 days post-surgery. Primary outcome was mortality within 1 year. We used multivariable Cox proportional hazard regression analysis to assess independent associations between AKI type and mortality.
Most patients with AKI were classified as transient (84%). Compared to patients without AKI, both patients with transient and persistent AKI demonstrated elevated 1-year mortality rates [adjusted hazard ratio (95% confidence interval): 2.01 (1.34-2.93); P = 0.001, and 6.20 (3.00-11.43); P < 0.001, respectively] and greater risk of chronic kidney disease progression at 1 year [adjusted odds ratio (95% confidence interval): 3.87 (2.12-7.08) and 23.70 (9.64-58.22), respectively; both P < 0.001].
Although most AKI cases after major abdominal surgery recover completely within 7 days, even these patients with transient AKI are at higher risk for 1-year mortality and chronic kidney disease progression compared to patients without AKI.
我们进行了一项回顾性队列研究，以确定重大腹部手术后一过性和持续性急性肾损伤（AKI）的发生率及其对长期结局的影响。
我们纳入了 3751 名接受重大腹部手术的患者。术后 AKI 根据术后 7 天内血清肌酐恢复至非 AKI 范围分为一过性或持续性。主要结局为 1 年内的死亡率。我们使用多变量 Cox 比例风险回归分析评估 AKI 类型与死亡率之间的独立关联。
大多数 AKI 患者被归类为一过性（84%）。与无 AKI 的患者相比，一过性和持续性 AKI 患者的 1 年死亡率均升高[校正后的危险比（95%置信区间）：2.01（1.34-2.93）；P=0.001，和 6.20（3.00-11.43）；P<0.001]，1 年时慢性肾脏病进展的风险更高[校正后的优势比（95%置信区间）：3.87（2.12-7.08）和 23.70（9.64-58.22）；均 P<0.001]。
尽管重大腹部手术后的大多数 AKI 病例在 7 天内完全恢复，但即使是这些一过性 AKI 患者，与无 AKI 的患者相比，1 年死亡率和慢性肾脏病进展的风险也更高。
