累积液体平衡对肝移植后急性肾损伤和患者结局的影响：一项回顾性队列研究。

Effect of cumulative fluid balance on acute kidney injury and patient outcomes after orthotopic liver transplantation: A retrospective cohort study.

机构信息

Department of Anesthesiology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.

Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.

出版信息

Nephrology (Carlton). 2020 Sep;25(9):700-707. doi: 10.1111/nep.13702. Epub 2020 Mar 12.

DOI:10.1111/nep.13702

PMID:32105370

Abstract

AIM

Acute kidney injury (AKI) is a serious complication following orthotopic liver transplantation (OLT) and it affects long-term patient survival. The aims of this study were to identify the effects of cumulative fluid balance (FB) on early post-OLT AKI and adverse outcomes and to construct a model to predict AKI.

METHODS

We retrospectively analysed 146 adult patients who underwent OLT. AKI severity was classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Univariate and multivariate logistic regression analyses were used to evaluate the association between cumulative FB and post-OLT AKI. The Kaplan-Meier method was used to estimate the survival rate.

RESULTS

Within the perioperative period of 72 hours, 50% (66/132) of patients developed AKI, with 36 (54%), 16 (24%) and 14 (21%) patients having AKI stages 1, 2 and 3, respectively. The cumulative FB was the risk factors for post-OLT AKI (odds ratio [OR], 1.011; 95% confidence interval [CI], 1.156~~6.001; P = .021). Preoperative albumin was a protective factor for post-OLT AKI (OR, 0.309; 95% CI, 0.140~~0.731; P = .007). The AKI group requires renal replacement therapy (RRT) more (15.2% vs 0%, P = .001) and associated with postoperative complications (56% vs 28.8%, P = .003). The complication-free survival was lower in the AKI group ([11.90 vs 18.74] months, χ = 9.60, P = .002).

CONCLUSION

Cumulative FB within 72 hours is associated with post-OLT AKI and requires RRT. Cumulative FB impacts the long-term complication-free survival of the recipients.

摘要

目的

急性肾损伤（AKI）是肝移植（OLT）后的严重并发症，影响患者的长期生存。本研究旨在确定累积液体平衡（FB）对 OLT 后早期 AKI 及不良预后的影响，并构建预测 AKI 的模型。

方法

我们回顾性分析了 146 例接受 OLT 的成年患者。根据改善全球肾脏病预后组织（KDIGO）标准对 AKI 严重程度进行分类。采用单因素和多因素逻辑回归分析评估累积 FB 与 OLT 后 AKI 的关系。采用 Kaplan-Meier 法估计生存率。

结果

在围手术期 72 小时内，50%（66/132）的患者发生 AKI，其中 36（54%）、16（24%）和 14（21%）例患者 AKI 分期分别为 1 期、2 期和 3 期。累积 FB 是 OLT 后 AKI 的危险因素（优势比[OR]，1.011；95%置信区间[CI]，1.156~~6.001；P =.021）。术前白蛋白是 OLT 后 AKI 的保护因素（OR，0.309；95%CI，0.140~~0.731；P =.007）。AKI 组需要肾脏替代治疗（RRT）更多（15.2% vs 0%，P =.001），并与术后并发症相关（56% vs 28.8%，P =.003）。AKI 组无并发症生存率较低（[11.90 比 18.74]个月，χ = 9.60，P =.002）。