血清肌酐围手术期使用与术后急性肾损伤：一项探索医生认知与实践的单中心观察性回顾研究
Perioperative use of serum creatinine and postoperative acute kidney injury: a single-centre, observational retrospective study to explore physicians' perception and practice.
作者信息
Villa Gianluca, De Rosa Silvia, Scirè Calabrisotto Caterina, Nerini Alessandro, Saitta Thomas, Degl'Innocenti Dario, Paparella Laura, Bocciero Vittorio, Allinovi Marco, De Gaudio Angelo R, Ostermann Marlies, Romagnoli Stefano
机构信息
Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
出版信息
Perioper Med (Lond). 2021 May 25;10(1):13. doi: 10.1186/s13741-021-00184-6.
BACKGROUND
Postoperative acute kidney injury (PO-AKI) is a leading cause of short- and long-term morbidity and mortality, as well as progression to chronic kidney disease (CKD). The aim of this study was to explore the physicians' attitude toward the use of perioperative serum creatinine (sCr) for the identification of patients at risk for PO-AKI and long-term CKD. We also evaluated the incidence and risk factors associated with PO-AKI and renal function deterioration in patients undergoing major surgery for malignant disease.
METHODS
Adult oncological patients who underwent major abdominal surgery from November 2016 to February 2017 were considered for this single-centre, observational retrospective study. Routinely available sCr values were used to define AKI in the first three postoperative days. Long-term kidney dysfunction (LT-KDys) was defined as a reduction in the estimated glomerular filtration rate by more than 10 ml/min/m at 12 months postoperatively. A questionnaire was administered to 125 physicians caring for the enrolled patients to collect information on local attitudes regarding the use of sCr perioperatively and its relationship with PO-AKI.
RESULTS
A total of 423 patients were observed. sCr was not available in 59 patients (13.9%); the remaining 364 (86.1%) had at least one sCr value measured to allow for detection of postoperative kidney impairment. Among these, PO-AKI was diagnosed in 8.2% of cases. Of the 334 patients who had a sCr result available at 12-month follow-up, 56 (16.8%) developed LT-KDys. Data on long-term kidney function were not available for 21% of patients. Interestingly, 33 of 423 patients (7.8%) did not have a sCr result available in the immediate postoperative period or long term. All the physicians who participated in the survey (83 out of 125) recognised that postoperative assessment of sCr is required after major oncological abdominal surgery, particularly in those patients at high risk for PO-AKI and LT-KDys.
CONCLUSION
PO-AKI after major surgery for malignant disease is common, but clinical practice of measuring sCr is variable. As a result, the exact incidence of PO-AKI and long-term renal prognosis are unclear, including in high-risk patients.
TRIAL REGISTRATION
ClinicalTrials.gov , NCT04341974 .
背景
术后急性肾损伤（PO-AKI）是短期和长期发病及死亡的主要原因，也是进展为慢性肾脏病（CKD）的原因。本研究的目的是探讨医生对围手术期血清肌酐（sCr）用于识别PO-AKI和长期CKD风险患者的态度。我们还评估了接受恶性疾病大手术患者中PO-AKI和肾功能恶化的发生率及相关危险因素。
方法
本单中心观察性回顾性研究纳入了2016年11月至2017年2月接受腹部大手术的成年肿瘤患者。术后前三天常规获取的sCr值用于定义AKI。长期肾功能障碍（LT-KDys）定义为术后12个月时估计肾小球滤过率降低超过10 ml/min/m²。对125名负责所纳入患者的医生进行问卷调查，以收集关于围手术期使用sCr的当地态度及其与PO-AKI关系的信息。
结果
共观察了423例患者。59例患者（13.9%）未获取到sCr值；其余364例（86.1%）至少测量了一次sCr值以检测术后肾脏损害。其中，8.2%的病例被诊断为PO-AKI。在12个月随访时有sCr结果的334例患者中，56例（16.8%）发生了LT-KDys。21%的患者没有长期肾功能数据。有趣的是，423例患者中有33例（7.8%）术后即刻或长期未获取到sCr结果。所有参与调查的医生（125名中的83名）都认识到，肿瘤腹部大手术后需要对sCr进行术后评估，特别是在那些有PO-AKI和LT-KDys高风险的患者中。
结论
恶性疾病大手术后的PO-AKI很常见，但测量sCr的临床实践存在差异。因此，PO-AKI的确切发生率和长期肾脏预后尚不清楚，包括在高危患者中。
试验注册
ClinicalTrials.gov，NCT04341974 。
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