Department of Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
Critical Care Nephrology Research Center, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
BMC Anesthesiol. 2019 Sep 2;19(1):171. doi: 10.1186/s12871-019-0842-3.
Acute kidney injury (AKI) is a common complication following non-cardiac surgery with adverse short- and long- term morbidity and mortality. Evidence shows that hypoalbuminemia is associated with increased AKI risk in patients with infectious diseases and cancer and following cardiac surgery and transplant surgery. However, little evidence is available on non-cardiac surgery population. Thus, we investigated the association between preoperative hypoalbuminemia and AKI following non-cardiac surgery.
We retrospectively assessed perioperative risk factors and preoperative serum albumin concentration in 729 consecutive adult patients who underwent non-cardiac surgery from July 1, 2017, to June 30, 2018. Each patient was categorized according to maximal Kidney Disease Improving Global Outcomes criteria based on creatinine changes and urine output within the first week after surgery. Multivariate Logistic regression models were used to analyze the association between preoperative hypoalbuminemia and postoperative AKI.
Of 729 patients, 188 (25.8%) developed AKI. AKI incidence was higher in patients with preoperative serum albumin < 37.5 g/L than in those with preoperative serum albumin ≥37.5 g/L [35.9% (98/273) vs. 19.7% (90/456), P < 0.001]. Multivariate logistic regression analysis showed that preoperative serum albumin < 37.5 g/L (odds ratio 1.892; 95% confidence interval 1.238-2.891; P = 0.003) was independently associated with postoperative AKI. Patients with preoperative serum albumin < 37.5 g/L tended to have a higher but not significant ratio in AKI stage 2 (2.6% vs 1.1%, P = 0.144) and much higher ratio in AKI stage 3 (4.8% vs 0.7%, P < 0.001) than those with preoperative serum albumin ≥37.5 g/L. AKI patients had a higher in-hospital mortality rate [6.9% (13/188) vs. 0.2% (1/541), P < 0.001]. Kaplan-Meier analysis revealed that the cumulative survival rate decreased with increasing AKI severity (P < 0.001). Postoperative AKI was also associated with other worse outcomes, such as prolonged mechanical ventilation [53.4 (33.0, 73.8) vs 14.7 (11.1, 18.3) hours, P < 0.001], intensive care unit stay [4.0 (3.1, 4.9) vs 2.0 (1.8, 2.3) days, P < 0.001], postoperative hospital stay [17.8 (14.8, 20.9) vs 12.3 (11.3, 13.3) days, P < 0.001], and higher total cost [13,453 (8538, 20,228) vs 11,306 (6277, 16,400) dollars, P < 0.001].
Preoperative hypoalbuminemia was independently associated with AKI after non-cardiac surgery, and postoperative AKI was associated with poor outcomes.
急性肾损伤（AKI）是一种常见的非心脏手术后并发症，具有短期和长期的不良发病率和死亡率。有证据表明，低白蛋白血症与传染病和癌症患者以及心脏手术后和移植手术后的 AKI 风险增加有关。然而，在非心脏手术人群中，证据有限。因此，我们研究了非心脏手术后术前低白蛋白血症与 AKI 的关系。
我们回顾性评估了 2017 年 7 月 1 日至 2018 年 6 月 30 日期间接受非心脏手术的 729 例连续成年患者的围手术期危险因素和术前血清白蛋白浓度。根据术后第一周内肌酐变化和尿量，每位患者根据最大肾脏病改善全球结局标准进行分类。多变量逻辑回归模型用于分析术前低白蛋白血症与术后 AKI 之间的关系。
在 729 例患者中，188 例（25.8%）发生 AKI。术前血清白蛋白<37.5g/L 的患者 AKI 发生率高于术前血清白蛋白≥37.5g/L 的患者[35.9%（98/273）比 19.7%（90/456），P<0.001]。多变量 logistic 回归分析显示，术前血清白蛋白<37.5g/L（比值比 1.892；95%置信区间 1.238-2.891；P=0.003）与术后 AKI 独立相关。术前血清白蛋白<37.5g/L 的患者 AKI 期 2 的比例较高（2.6%比 1.1%，P=0.144），AKI 期 3 的比例高得多（4.8%比 0.7%，P<0.001）比术前血清白蛋白≥37.5g/L 的患者。AKI 患者住院死亡率较高[6.9%（13/188）比 0.2%（1/541），P<0.001]。Kaplan-Meier 分析显示，累积生存率随 AKI 严重程度的增加而降低（P<0.001）。术后 AKI 还与其他不良结局相关，如机械通气时间延长[53.4（33.0，73.8）比 14.7（11.1，18.3）小时，P<0.001]、重症监护病房停留时间[4.0（3.1，4.9）比 2.0（1.8，2.3）天，P<0.001]、术后住院时间[17.8（14.8，20.9）比 12.3（11.3，13.3）天，P<0.001]和总费用增加[13453（8538，20228）比 11306（6277，16400）美元，P<0.001]。
术前低白蛋白血症与非心脏手术后 AKI 独立相关，术后 AKI 与不良结局相关。
