肝切除术后急性肾损伤是可以合理预测的。
Acute kidney injury after hepatectomy can be reasonably predicted after surgery.
机构信息
Department of Anesthesiology, Columbia University Medical Center, 622 West 168th Street, PH 5, Suite 505C, New York, NY 10032, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
出版信息
J Hepatobiliary Pancreat Sci. 2019 Apr;26(4):144-153. doi: 10.1002/jhbp.615. Epub 2019 Mar 21.
BACKGROUND
Hepatectomy presents unique challenges potentially heightening acute kidney injury (AKI) risk, but the full spectrum of risk factors has not been identified.
METHODS
Data for hepatectomy patients in the 2016 American College of Surgeons National Surgical Quality Improvement Program (n = 3,814) was randomly split into derivation (70%) and validation (30%) cohorts. AKI was defined as an increase in serum creatinine ≥0.3 mg/dl or ≥1.5-fold above the preoperative value within 30 days of surgery. Multivariable logistic regression assessed preoperative and intraoperative risk factors for AKI.
RESULTS
Of 2,692 patients (derivation cohort), 432 (16%) developed AKI. Risk factors were the following: age (years; adjusted odds ratio [aOR] 1.016 [95% confidence interval 1.006-1.026], female sex (aOR 0.65 [0.51-0.82]), body mass index (kg/m ; aOR 1.043 [1.024-1.062]), diabetes (aOR 1.71 [1.31-2.24]), hypertension (aOR 1.66 [1.30-2.13]), hematocrit (%; aOR 0.944 [0.924-0.966]), operative time (min; aOR 1.004 [1.003-1.004]), planned open procedure (aOR 2.00 [1.47-2.73]), and Pringle maneuver (aOR 1.36 [1.07-1.72]). The areas under the curve of the receiver operating characteristic curves were 0.74 (95% CI 0.71-0.76) and 0.71 (95% CI 0.67-0.75) in the derivation and validation cohorts, respectively.
CONCLUSIONS
Postoperative AKI affects one in six hepatectomy patients; preoperative and intraoperative factors can predict the risk of postoperative AKI.
背景
肝切除术具有独特的挑战性，可能会增加急性肾损伤（AKI）的风险，但尚未确定所有的风险因素。
方法
2016 年美国外科医师学院国家外科质量改进计划（n = 3814）中肝切除术患者的数据被随机分为推导（70%）和验证（30%）队列。AKI 的定义为术后 30 天内血清肌酐升高≥0.3mg/dl 或比术前值升高≥1.5 倍。多变量逻辑回归评估了 AKI 的术前和术中危险因素。
结果
在 2692 例患者（推导队列）中，有 432 例（16%）发生 AKI。危险因素包括：年龄（岁；调整后比值比[aOR]1.016[95%置信区间 1.006-1.026]）、女性（aOR 0.65[0.51-0.82]）、体重指数（kg/m ；aOR 1.043[1.024-1.062]）、糖尿病（aOR 1.71[1.31-2.24]）、高血压（aOR 1.66[1.30-2.13]）、血细胞比容（%；aOR 0.944[0.924-0.966]）、手术时间（min；aOR 1.004[1.003-1.004]）、计划开放手术（aOR 2.00[1.47-2.73]）和普雷灵手法（aOR 1.36[1.07-1.72]）。推导和验证队列的受试者工作特征曲线下面积分别为 0.74（95%置信区间 0.71-0.76）和 0.71（95%置信区间 0.67-0.75）。
结论
术后 AKI 影响六分之一的肝切除术患者；术前和术中因素可预测术后 AKI 的风险。
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