Uusalo Panu, Hellman Tapio, Järvisalo Mikko J
Department of Anaesthesiology and Intensive Care, University of Turku, P.O. Box 51, Kiinamyllynkatu 4-8, FI-20521, Turku, Finland.
Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
Perioper Med (Lond). 2021 Dec 14;10(1):57. doi: 10.1186/s13741-021-00227-y.
Perioperative acute kidney injury (AKI) is associated with multiple postoperative complications leading to prolonged hospital stay and higher costs. AKI requiring continuous renal replacement therapy (CRRT) after surgery has an incidence of 2-6% and mortality approximates 40-60%. Previous studies examining mortality in perioperative AKI patients managed with CRRT have concentrated on cardiac surgery patients and there are very limited data on broad surgical patient populations requiring CRRT. We examined long-term mortality and factors associated with poor outcome in a broad surgical population requiring CRRT for perioperative AKI during a 10-year period.
Surgical patients admitted to the intensive care unit (ICU) of academic tertiary hospital requiring CRRT between years 2010-2019 were included. CRRT was performed using regional citrate-calcium-anticoagulation. Extracted data included patient demographics, comorbidities, and clinical parameters at ICU admission and at the initiation of CRRT. Creatinine and estimated glomerular filtration rate (eGFR) were measured at 1 year after ICU admission.
A total of 157 patients were included in the study. ICU mortality was 42.7%, 90-day mortality 58.0% and 1-year mortality 62.4%. Blood lactate at ICU admission and CRRT initiation were independently associated with mortality in the multivariate models. Patients with lactate > 4 mmol/l had higher mortality than patients with normal lactate (77% vs. 21%) (p < 0.001). Creatinine (p = 0.004) and eGFR (p < 0.001) remained significantly altered at 1 year of follow-up compared to baseline.
Patients undergoing surgery and requiring perioperative CRRT in the ICU have a high risk of mortality. Mortality appears to be independently associated with lactate levels.
围手术期急性肾损伤（AKI）与多种术后并发症相关，会导致住院时间延长和费用增加。术后需要持续肾脏替代治疗（CRRT）的AKI发生率为2%-6%，死亡率约为40%-60%。既往研究围手术期接受CRRT治疗的AKI患者死亡率时，主要集中在心脏手术患者，而关于需要CRRT的广泛外科患者群体的数据非常有限。我们研究了在10年期间，因围手术期AKI需要CRRT的广泛外科患者群体的长期死亡率及与不良结局相关的因素。
纳入2010年至2019年期间入住学术性三级医院重症监护病房（ICU）并需要CRRT的外科患者。采用局部枸橼酸-钙抗凝进行CRRT。提取的数据包括患者人口统计学资料、合并症以及入住ICU时和开始CRRT时的临床参数。在入住ICU 1年后测量肌酐和估算肾小球滤过率（eGFR）。
共157例患者纳入研究。ICU死亡率为42.7%，90天死亡率为58.0%，1年死亡率为62.4%。在多变量模型中，入住ICU时和开始CRRT时的血乳酸与死亡率独立相关。乳酸>4 mmol/L的患者死亡率高于乳酸正常的患者（77%对21%）（p<0.001）。与基线相比，随访1年时肌酐（p = 0.004）和eGFR（p<0.001）仍有显著变化。
在ICU接受手术且围手术期需要CRRT的患者死亡率高。死亡率似乎与乳酸水平独立相关。
