Halmy Laszlo, Riedel Joshua, Zeman Florian, Tege Birgit, Linder Volker, Gnewuch Carsten, Graf Bernhard M, Schlitt Hans J, Bergler Tobias, Göcze Ivan
Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
Medical Faculty, University of Regensburg, Universitätsstraße 31, 93053 Regensburg, Germany.
J Clin Med. 2021 Oct 31;10(21):5122. doi: 10.3390/jcm10215122.
The facilitation of early recovery of acute kidney injury (AKI) is an important step to improve outcome, particularly because of the limited therapeutic interventions currently available for AKI. The combination of an electronic alert and biomarker-guided kidney-protection strategy implemented in the routine care may have an impact on the incidence of early complete reversal of AKI after major non-cardiac surgery. We studied 294 patients in two cohorts before ( = 151) and after protocol implementation ( = 143). Data collection required 6 months for each cohort. The kidney-protection protocol included an electronic alert to detect patients who were eligible for urinary biomarker [TIMP2 × IGFBP7]-guided kidney-protection intervention. Intervention was stratified according to three levels of immediate AKI risk: low, moderate, and high. After intervention, postoperative changes in the glomerular filtration rate (eGFR) were identified with a tracking software that included an alert for nephrology consultation if the eGFR had declined by >25% from the preoperative reference value. Primary outcome was early AKI recovery, i.e., the complete reversal of any AKI stage to absence of AKI within the first 7 postoperative days. Protocol implementation significantly increased the recovery of AKI (36/46, 78% compared to control 27/48, 56%, ( = 0.025)) and reduced the length of the ICU stay ( < 0.001). There was no significant difference in the overall incidence of all AKI and moderate and severe AKI in the first 7 postoperative days: 46/143 (32%) and 12/151 (8%) in the protocol implementation group compared to 48/151 (32%) and 18/151 (12%) in the historical control group. Patients with AKI reversal within the first 7 postoperative days had lower in-hospital mortality than patients without AKI reversal. Implementing a combined electronic alert and biomarker-guided kidney-protection strategy in routine care improved early recovery of AKI after major surgery.
促进急性肾损伤（AKI）的早期恢复是改善预后的重要一步，特别是考虑到目前针对AKI的治疗干预措施有限。在常规护理中实施电子警报和生物标志物引导的肾脏保护策略，可能会对重大非心脏手术后AKI早期完全逆转的发生率产生影响。我们在两个队列中研究了294例患者，一个队列是在方案实施前（n = 151），另一个队列是在方案实施后（n = 143）。每个队列的数据收集需要6个月。肾脏保护方案包括一个电子警报，以检测符合尿生物标志物[TIMP2×IGFBP7]引导的肾脏保护干预条件的患者。干预根据急性肾损伤的三个即时风险水平进行分层：低、中、高。干预后，使用跟踪软件识别肾小球滤过率（eGFR）的术后变化，如果eGFR较术前参考值下降>25%，该软件会发出肾脏科会诊警报。主要结局是AKI的早期恢复，即在术后第1个7天内将任何AKI阶段完全逆转至无AKI。方案实施显著提高了AKI的恢复率（36/46，78%，而对照组为27/48，56%，P = 0.025），并缩短了ICU住院时间（P < 0.001）。术后第1个7天内所有AKI以及中度和重度AKI的总体发生率无显著差异：方案实施组为46/143（32%）和12/151（8%），历史对照组为48/151（32%）和18/151（12%）。术后第1个7天内发生AKI逆转的患者的住院死亡率低于未发生AKI逆转的患者。在常规护理中实施电子警报和生物标志物引导的联合肾脏保护策略可改善重大手术后AKI的早期恢复。
