主要胃肠手术患者术后急性肾损伤对 1 年生存率和肾脏结局的影响：一项全国多中心队列研究。

BACKGROUND

The intermediate-term impact of acute kidney injury (AKI) in patients after major gastrointestinal and liver surgery has not been well characterized. This study aimed to evaluate the 1-year mortality rate and renal outcomes associated with postoperative AKI in a national prospective cohort.

METHODS

This prospective multicentre, observational cohort with 1-year postoperative follow-up included adults undergoing major gastrointestinal and liver surgery across the UK and Ireland between 23 September and 18 November 2015. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The primary outcome was death at 1-year after surgery, and the secondary outcome was Major Adverse Kidney Events (MAKE-365). Cox proportionate and multilevel logistic regression were used to account for case mix.

RESULTS

Of 5745 patients across 173 centres, 1-year follow-up data was completed for 3504 patients (62.2 per cent, 126 centres), with attrition largely explained by centre non-participation (63.1 per cent). Some 13.6 per cent (475 of 3504) patients developed AKI by 7 days after surgery (stage 1: 9.2 per cent; stage 2/3: 4.3 per cent). At 1 year, 10.8 per cent (378 patients) experienced a MAKE-365 endpoint (303 patients had died, 61 had renal replacement therapy and 78 had renal dysfunction). Patients who experienced AKI by 7 days after surgery had a higher hazard of death at 1 year for KDIGO stage 1 (hazard ratio 1.50 (95 per cent c.i. 1.08 to 2.08), P = 0.016) and KDIGO stage 2/3 (hazard ratio 2.96 (95 per cent c.i. 2.02 to 4.33), P < 0.001). Both KDIGO stage 1 (odds ratio 2.09 (95 per cent c.i. 1.50 to 2.92), P < 0.001) and stage 2/3 (odds ratio 9.26 (95 per cent c.i. 6.31 to 13.59), P < 0.001) AKI were independently associated with MAKE-365.

CONCLUSION

AKI events within 7 days after gastrointestinal or liver surgery are associated with significantly worse survival and renal outcomes at 1 year.

背景

急性肾损伤（AKI）在胃肠道和肝脏大手术后患者的中期影响尚未得到很好的描述。本研究旨在评估英国和爱尔兰全国前瞻性队列中术后 AKI 与 1 年死亡率和肾脏结局的关系。

方法

这项前瞻性多中心观察性队列研究在 2015 年 9 月 23 日至 11 月 18 日期间纳入了接受胃肠道和肝脏大手术的成年人，术后随访 1 年。AKI 根据肾脏疾病改善全球结局（KDIGO）标准定义。主要结局为术后 1 年的死亡，次要结局为主要不良肾脏事件（MAKE-365）。Cox 比例风险和多水平逻辑回归用于解释病例组合。

结果

在 173 个中心的 5745 名患者中，有 3504 名患者（62.2%，126 个中心）完成了 1 年的随访数据，失访主要归因于中心不参与（63.1%）。约 13.6%（475 例/3504 例）患者在术后 7 天内发生 AKI（1 期：9.2%；2/3 期：4.3%）。在 1 年时，10.8%（378 例）患者发生 MAKE-365 终点事件（303 例死亡，61 例需要肾脏替代治疗，78 例肾功能障碍）。术后 7 天内发生 AKI 的患者 1 年死亡的风险更高，KDIGO 1 期（风险比 1.50[95%置信区间 1.08 至 2.08]，P=0.016）和 KDIGO 2/3 期（风险比 2.96[95%置信区间 2.02 至 4.33]，P<0.001）。KDIGO 1 期（比值比 2.09[95%置信区间 1.50 至 2.92]，P<0.001）和 2/3 期（比值比 9.26[95%置信区间 6.31 至 13.59]，P<0.001）的 AKI 均与 MAKE-365 独立相关。