Filiberto Amanda C, Miao Shunshun, Ren Yuanfang, Ozrazgat-Baslanti Tezcan, Hensley Sara E, Jacobs Christopher R, Weaver M Libby, Upchurch Gilbert R, Bihorac Azra, Cooper Michol
Department of Surgery, University of Florida, Gainesville, FL, United States of America.
Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL, United States of America.
Surg Open Sci. 2023 Jun 12;14:17-21. doi: 10.1016/j.sopen.2023.06.001. eCollection 2023 Aug.
Incidental atherosclerotic renal artery stenosis (RAS) is common in patients undergoing vascular surgery and has been shown to be associated with postoperative AKI among patients undergoing major non-vascular surgeries. We hypothesized that patients with RAS undergoing major vascular procedures would have a higher incidence of AKI and postoperative complications than those without RAS.
A single-center retrospective cohort study of 200 patients who underwent elective open aortic or visceral bypass surgery (100 with postoperative AKI; 100 without AKI) were identified. RAS was then evaluated by review of pre-surgery CTAs with readers blinded to AKI status. RAS was defined as ≥50 % stenosis. Univariate and multivariable logistic regression was used to assess association of unilateral and bilateral RAS with postoperative outcomes.
17.4 % (n = 28) of patients had unilateral RAS while 6.2 % (n = 10) of patients had bilateral RAS. Patients with bilateral RAS had similar preadmission creatinine and GFR as compared to unilateral RAS or no RAS. 100 % (n = 10) of patients with bilateral RAS had postoperative AKI compared with 45 % (n = 68) of patients with unilateral or no RAS (p < 0.05). In adjusted logistic regression models, bilateral RAS predicted severe AKI (OR 5.82; CI 1.33, 25.53; p = 0.02), in-hospital mortality (OR 5.71; CI 1.03, 31.53; p = 0.05), 30-day mortality (OR 10.56; CI 2.03, 54.05; p = 0.005) and 90-day mortality (OR 6.88; CI 1.40, 33.87; p = 0.02).
Bilateral RAS is associated with increased incidence of AKI as well as in-hospital, 30-day, and 90-day mortality suggesting it is a marker of poor outcomes and should be considered in preoperative risk stratification.
偶发性动脉粥样硬化性肾动脉狭窄（RAS）在接受血管手术的患者中很常见，并且在接受大型非血管手术的患者中已被证明与术后急性肾损伤（AKI）有关。我们假设，接受大型血管手术的RAS患者比没有RAS的患者发生AKI和术后并发症的发生率更高。
对200例行择期开放性主动脉或内脏搭桥手术的患者进行单中心回顾性队列研究（100例发生术后AKI；100例未发生AKI）。然后由对AKI状态不知情的阅片者通过术前CTA评估RAS。RAS定义为狭窄≥50%。采用单因素和多因素logistic回归分析评估单侧和双侧RAS与术后结局的相关性。
17.4%（n = 28）的患者有单侧RAS，而6.2%（n = 10）的患者有双侧RAS。与单侧RAS或无RAS的患者相比，双侧RAS患者入院前的肌酐和肾小球滤过率（GFR）相似。双侧RAS患者术后AKI的发生率为100%（n = 10），而单侧或无RAS患者的这一比例为45%（n = 68）（p < 0.05）。在调整后的logistic回归模型中，双侧RAS可预测严重AKI（比值比[OR]5.82；95%置信区间[CI]1.33，25.53；p = 0.02）、住院死亡率（OR 5.71；CI 1.03，31.53；p = 0.05）、30天死亡率（OR 10.56；CI 2.03，54.05；p = 0.005）和90天死亡率（OR 6.88；CI 1.40，33.87；p = 0.02）。
双侧RAS与AKI发生率增加以及住院、30天和90天死亡率增加相关，提示它是预后不良的一个标志物，术前风险分层时应予以考虑。
