Department of Vascular and Endovascular Surgery, University Hospital Aachen, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
Department of Vascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Sci Rep. 2023 Jul 9;13(1):11096. doi: 10.1038/s41598-023-38242-2.
Acute kidney injury (AKI) is a common complication after complex aortic procedures and it is associated with relevant mortality and morbidity. Biomarkers for early and specific AKI detection are lacking. The aim of this work is to investigate the reliability of the NephroCheck bedside system for diagnosing stage 3 AKI following open aortic surgery. In this prospective, multicenter, observational study,- https://clinicaltrials.gov/ct2/show/NCT04087161 -we included 45 patients undergoing open thoracoabdominal aortic repair. AKI risk (AKIRisk-Index) was calculated from urine samples at 5 timepoints: baseline, immediately postoperatively and at 12, 24, 48, and 72 h post-surgery. AKIs were classified according to the KDIGO criteria. Contributing factors were identified in univariable and multivariable logistic regression. Predictive ability was assessed with the area under the receiver operator curve (ROCAUC). Among 31 patients (68.8%) that developed AKIs, 21 (44.9%) developed stage-3 AKIs, which required dialysis. AKIs were correlated with increased in-hospital mortality (p = .006), respiratory complications (p < .001), sepsis (p < .001), and multi-organ dysfunction syndrome (p < .001). The AKIRisk-Index showed reliable diagnostic accuracy starting at 24 h post-surgery (ROCAUC: .8056, p = .001). In conclusion, starting at 24 h after open aortic repair, the NephroCheck system showed adequate diagnostic accuracy for detecting the patients at risk for stage 3 AKIs.
急性肾损伤 (AKI) 是复杂主动脉手术后的常见并发症，与相关死亡率和发病率有关。目前缺乏用于早期和特异性 AKI 检测的生物标志物。本研究旨在探讨 NephroCheck 床边系统在诊断开放式主动脉手术后 3 期 AKI 的可靠性。在这项前瞻性、多中心、观察性研究中，- https://clinicaltrials.gov/ct2/show/NCT04087161 -我们纳入了 45 名接受开放式胸腹主动脉修复的患者。AKI 风险（AKIRisk-Index）通过 5 个时间点的尿液样本计算得出：基线、术后即刻以及术后 12、24、48 和 72 小时。AKI 根据 KDIGO 标准进行分类。在单变量和多变量逻辑回归中确定了相关因素。通过接收者操作特征曲线 (ROCAUC) 评估预测能力。在 31 名发生 AKI 的患者中（68.8%），21 名（44.9%）发生了需要透析的 3 期 AKI。AKI 与住院期间死亡率增加（p = .006）、呼吸并发症（p < .001）、脓毒症（p < .001）和多器官功能障碍综合征（p < .001）相关。AKIRisk-Index 在术后 24 小时开始显示可靠的诊断准确性（ROCAUC：.8056，p = .001）。总之，在开放式主动脉修复后 24 小时开始，NephroCheck 系统显示出足够的诊断准确性，可用于检测发生 3 期 AKI 风险的患者。
