Pallares-Mendez Rigoberto, Cervantes-Miranda Daniel Eduardo, Castillo-Godinez Evelyn Susana, de la Cruz-de la Cruz Carlos, Aguilar-Méndez Marco Antonio, Gutierrez-Gonzalez Adrian, Mendoza-Castillo Fernando, Mata-Torres Héctor, Ochoa-Arvizo Mario, Montelongo-Rodriguez Fred, Hernandez-Aranda Katherine Lyn, Cota-Agüero Jesús Arturo
Department of Urology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez". Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico.
Department of Urology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Mexico.
Eur J Trauma Emerg Surg. 2023 Oct;49(5):2241-2248. doi: 10.1007/s00068-022-02006-w. Epub 2022 Jun 7.
To evaluate predictive and associated risk factors for nephrectomy in renal trauma and assess a 6-point score for surgical decision-making.
This multicenter, retrospective, and observational study assessed 247 subjects with blunt or penetrating kidney trauma. Kidney injuries were classified according to the American Association for the Surgery of Trauma (AAST) Injury Scoring Scale. Renal trauma was classified as "low-grade" (Grades I-III), Grade IV, and Grade V. Subjects were compared according to conservative treatment (CTrt.) or nephrectomy. Predictive factors were evaluated with a multiple regression model. A 6-point score was evaluated with a ROC analysis.
Patients requiring nephrectomy had a lower mean arterial pressure MAP compared to CTrt, 64.71 mmHg (SD ± 10.26) and 73.86 (SD ± 12.42), respectively (p = < 0.001). A response to IV solutions was observed in 90.2% of patients undergoing CTrt. (p = < 0.001, OR = 0.211, 95%CI = 0.101-0.442). Blood lactate ≥ 4 mmol/L was associated with nephrectomy (p = < 0.001). A hematoma ≥ 25 mm was observed in 41.5% of patients undergoing nephrectomy compared to 20.1% of CTrt. (p = 0.004, OR = 9.29, 95% CI = 1.37-5.58). A logistic regression analysis (p = < 0.001) showed that blood lactate ≥ 4 mmol/L (p = 0.043), an inadequate response to IV solutions (p = 0.041) and renal trauma grade IV-V (p = < 0.001), predicted nephrectomy. A 6-point score with a cut-off value ≥ 3 points showed 83% sensitivity and 87% specificity for nephrectomy with an AUC of 89.9% (p = < 0.001).
An inadequate response to IV solutions, a lactate level ≥ 4 mmol/L, and grade IV-V renal trauma predict nephrectomy. A score ≥ 3 points showed a good performance in this population.
评估肾外伤患者肾切除术的预测因素和相关危险因素，并评估用于手术决策的6分评分系统。
这项多中心、回顾性观察研究评估了247例钝性或穿透性肾外伤患者。肾损伤根据美国创伤外科协会（AAST）损伤评分量表进行分类。肾外伤分为“低级别”（I-III级）、IV级和V级。根据保守治疗（CTrt.）或肾切除术对患者进行比较。采用多元回归模型评估预测因素。通过ROC分析评估6分评分系统。
与接受保守治疗的患者相比，需要进行肾切除术的患者平均动脉压（MAP）较低，分别为64.71 mmHg（标准差±10.26）和73.86（标准差±12.42）（p = <0.001）。90.2%接受保守治疗的患者对静脉输液有反应（p = <0.001，OR = 0.211，95%CI = 0.101-0.442）。血乳酸≥4 mmol/L与肾切除术相关（p = <0.001）。接受肾切除术的患者中41.5%观察到血肿≥25 mm，而接受保守治疗的患者中这一比例为20.1%（p = 0.004，OR = 9.29，95%CI = 1.37-5.58）。逻辑回归分析（p = <0.001）显示，血乳酸≥4 mmol/L（p = 0.043）、对静脉输液反应不足（p = 0.041）和肾外伤IV-V级（p = <0.001）可预测肾切除术。截断值≥3分的6分评分系统对肾切除术的敏感性为83%，特异性为87%，曲线下面积（AUC）为89.9%（p = <0.001）。
对静脉输液反应不足、乳酸水平≥4 mmol/L和IV-V级肾外伤可预测肾切除术。评分≥3分在该人群中表现良好。
