Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
Outcome Research Consortium, Cleveland, OH, USA.
Intensive Care Med. 2023 Dec;49(12):1441-1455. doi: 10.1007/s00134-023-07169-7. Epub 2023 Jul 28.
The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear.
We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay.
We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration.
In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide.
不同国家和医疗体系中手术相关术后急性肾损伤（PO-AKI）的发生率、患者特征、危险因素和结局尚不清楚。
我们在 30 个国家的 10568 例接受大型手术（>2 小时手术时间和术后入住重症监护病房（ICU）或高依赖病房）的患者中进行了一项国际前瞻性、观察性、多中心研究。主要终点是根据肾脏病：改善全球结局（KDIGO）标准定义的术后 72 小时内发生的 PO-AKI。次要终点包括 PO-AKI 的严重程度和持续时间、肾脏替代治疗（RRT）的使用、死亡率以及 ICU 和住院时间。
我们研究了 10568 例患者，其中 1945 例（18.4%）发生 PO-AKI（1236 例[63.5%]为 KDIGO 第 1 期，500 例[25.7%]为 KDIGO 第 2 期，209 例[10.7%]为 KDIGO 第 3 期）。33.8%的 PO-AKI 持续存在，1945 例 PO-AKI 患者中有 170 例（8.7%）在 ICU 接受 RRT。发生 PO-AKI 的患者 ICU（6.3% vs. 0.7%）和医院（8.6% vs. 1.4%）死亡率更高，ICU（中位数 2（Q1-Q3，1-3）天 vs. 3（Q1-Q3，1-6）天）和住院时间（中位数 14（Q1-Q3，9-24）天 vs. 10（Q1-Q3，7-17）天）更长。PO-AKI 的危险因素包括年龄较大、合并症（高血压、糖尿病、慢性肾脏病）、手术类型、持续时间和紧急程度以及术中血管加压药和氨基糖苷类药物的使用。
在一项全面的多国研究中，大约五分之一的患者在接受大型手术后会发生 PO-AKI。PO-AKI 严重程度的增加与不良结局的逐渐增加相关。我们的研究结果表明，PO-AKI 代表了全球医疗保健的重大负担。
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