Department of Nephrology, Nara Medical University, Nara, Japan.
Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8602, Japan.
Sci Rep. 2019 Dec 30;9(1):20260. doi: 10.1038/s41598-019-56615-4.
This retrospective cohort study examined the roles of inflammation in acute kidney injury (AKI). Serum albumin and C-reactive protein (CRP) were used as markers of inflammation. Adults who underwent non-cardiac surgery from 2007 to 2011 were included. Exclusion criteria were urological surgery, obstetric surgery, missing data, and pre-operative dialysis. Subjects were followed until the end of 2015 or loss to follow-up. Associations between pre-operative albumin or CRP and post-operative AKI or association between AKI and mortality were examined by logistic or Cox regression, respectively. Mediation analyses were performed using albumin and CRP as mediators. Among 4,538 subjects, 272 developed AKI. Pre-operative albumin was independently associated with AKI (odds ratio [95% confidence interval (CI)]: 0.63 [0.48-0.83]). During a median follow-up of 4.5 years, 649 died. AKI was significantly associated with mortality (hazard ratio [HR] [95% CI]: 1.58 [1.22-2.04]). Further adjustment for pre-operative albumin and CRP attenuated the association (HR [95% CI]: 1.28 [0.99-1.67]). The proportions explained by mediating effects of lnCRP and albumin were 29.3% and 39.2% and mediation effects were statistically significant. In conclusion, inflammation is a predictor of AKI and a mediator of mortality after AKI. Interventions targeting inflammation might improve outcomes of AKI.
这项回顾性队列研究探讨了炎症在急性肾损伤（AKI）中的作用。血清白蛋白和 C 反应蛋白（CRP）被用作炎症的标志物。纳入 2007 年至 2011 年期间接受非心脏手术的成年人。排除标准为泌尿外科手术、产科手术、数据缺失和术前透析。研究对象随访至 2015 年底或随访结束。通过逻辑回归或 Cox 回归分别评估术前白蛋白或 CRP 与术后 AKI 的关系以及 AKI 与死亡率的关系。使用白蛋白和 CRP 作为中介物进行中介分析。在 4538 名受试者中，有 272 名发生 AKI。术前白蛋白与 AKI 独立相关（优势比 [95%置信区间（CI）]：0.63 [0.48-0.83]）。在中位随访 4.5 年期间，有 649 人死亡。AKI 与死亡率显著相关（风险比 [HR] [95% CI]：1.58 [1.22-2.04]）。进一步调整术前白蛋白和 CRP 后，相关性减弱（HR [95% CI]：1.28 [0.99-1.67]）。lnCRP 和白蛋白的中介效应解释比例分别为 29.3%和 39.2%，且中介效应具有统计学意义。总之，炎症是 AKI 的预测因子，也是 AKI 后死亡率的中介。针对炎症的干预措施可能改善 AKI 的预后。
