Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
BJS Open. 2021 Sep 6;5(5). doi: 10.1093/bjsopen/zrab077.
Acute kidney injury (AKI) is increasingly being recognized after hepatectomy. This study aimed to identify factors predicting its occurrence and its impact on long-term outcome among patients with hepatocellular carcinoma (HCC).
This was a retrospective analysis of the incidence of AKI, factors predicting its occurrence, and its impact on patients undergoing hepatectomy between September 2007 and December 2018. A subgroup analysis included patients with histologically proven HCC.
The incidence of AKI was 9.2 per cent in 930 patients. AKI was associated with increased mortality, morbidity, posthepatectomy liver failure (PHLF), and a longer hospital stay. On multivariable analysis, study period December 2013 to December 2018, diabetes mellitus, mean intraoperative BP below 72.1 mmHg, operative blood loss exceeding 377ml, high Model for End-Stage Liver Disease (MELD) score, and PHLF were predictive factors for AKI. Among 560 patients with HCC, hypertension, BP below 76.9 mmHg, blood loss greater than 378ml, MELD score, and PHLF were predictive factors. The 1-, 3-, and 5-year overall survival rates were 74.1, 59.2, and 51.6 per cent respectively for patients with AKI, and 91.8, 77.9, and 67.3 per cent for those without AKI. Corresponding 1-, 3-, and 5-year disease-free survival rates were 56.9, 42.3, and 35.4 per cent respectively in the AKI group, and 71.7, 54.5, and 46.2 per cent in the no-AKI group. AKI was an independent predictor of survival in multivariable analysis.
AKI is associated with longer hospital stay, and higher morbidity and mortality rates. It is also associated with shorter long-term survival among patients with HCC. To avoid AKI, control of blood loss and maintaining a reasonable BP (72-77 mmHg) during hepatectomy is important.
肝切除术后越来越多地认识到急性肾损伤（AKI）的发生。本研究旨在确定预测其发生的因素及其对肝细胞癌（HCC）患者长期预后的影响。
这是一项回顾性分析，研究了 2007 年 9 月至 2018 年 12 月期间接受肝切除术的患者 AKI 的发生率、预测其发生的因素及其对其的影响。亚组分析包括经组织学证实的 HCC 患者。
930 例患者中 AKI 的发生率为 9.2%。AKI 与死亡率、发病率、肝切除术后肝功能衰竭（PHLF）和住院时间延长有关。多变量分析显示，研究期间为 2013 年 12 月至 2018 年 12 月，糖尿病、术中平均血压低于 72.1mmHg、手术出血量超过 377ml、高终末期肝病模型（MELD）评分和 PHLF 是 AKI 的预测因素。在 560 例 HCC 患者中，高血压、血压低于 76.9mmHg、出血量大于 378ml、MELD 评分和 PHLF 是预测因素。AKI 患者的 1 年、3 年和 5 年总生存率分别为 74.1%、59.2%和 51.6%，无 AKI 患者分别为 91.8%、77.9%和 67.3%。AKI 组的 1 年、3 年和 5 年无病生存率分别为 56.9%、42.3%和 35.4%，无 AKI 组分别为 71.7%、54.5%和 46.2%。多变量分析显示，AKI 是生存的独立预测因素。
AKI 与住院时间延长、发病率和死亡率升高有关。它还与 HCC 患者的长期生存时间缩短有关。为避免 AKI，肝切除术中应控制出血量并维持合理的血压（72-77mmHg）。
