Alrzouq Fahad K, Dendini Fares, Alsuwailem Yousef, Aljaafri Bader A, Alsuhibani Abdulaziz S, Al Babtain Ibrahim
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.
Department of Research Office, King Abdullah International Medical Research Center, Riyadh, SAU.
Cureus. 2023 Aug 28;15(8):e44245. doi: 10.7759/cureus.44245. eCollection 2023 Aug.
Background This research study investigates the prevalence of acute kidney injury (AKI) in trauma patients undergoing emergency laparotomies. AKI is a common complication in major surgeries and is associated with various adverse effects. The study aims to explore the relationship between AKI and other comorbidities in this specific context. Methodology This is a retrospective cohort study. All patients who had laparotomy after abdominal trauma at King Abdulaziz Medical City (KAMC) and met the inclusion criteria were included in the study. Nonprobability consecutive sampling was used. Data were collected by chart review using the Best-Care system at KAMC. Descriptive statistics were used to summarize and describe the characteristics of the study participants. Frequencies and percentages were calculated for categorical variables, such as comorbidities. For continuous variables, mean and standard deviations were calculated and tabulated. All statistical calculations were performed using IBM SPSS Statistics for Windows, Version 27.0 (IBM Corp., Armonk, NY, USA). Results This research study included 152 patients who underwent laparotomy, and the majority of patients (146, 96%) did not experience AKI. Several comorbidities were observed, with hypertension and diabetes being the most prevalent at 37 (24.3%) and 35 (23%), respectively. Intraoperative hypotension was experienced by 23 (15.1%) patients, while 129 (84.9%) did not have this issue. Norepinephrine was the most common vasopressor used (25.7%), followed by ephedrine and a combination of norepinephrine and epinephrine. Gender and age groups did not show significant associations with AKI, comorbidities like diabetes, heart failure, and chronic kidney disease (CKD) demonstrated significant relationships with AKI. There was no significant difference in eGFR and serum creatinine baseline levels between patients meeting AKI criteria and those who did not. Conclusions The low overall incidence of AKI in this patient population is encouraging. However, healthcare professionals must be aware of the significant impact of comorbidities such as diabetes, heart failure, and CKD on AKI development. Vigilant monitoring of postoperative kidney function, particularly serum creatinine levels within the first 48 hours, is essential for early detection and timely intervention. By understanding and addressing these risk factors, healthcare providers can take proactive steps to prevent and manage AKI in patients undergoing laparotomy, ultimately leading to improved patient outcomes and reduced healthcare costs.
背景 本研究调查了接受急诊剖腹手术的创伤患者中急性肾损伤（AKI）的患病率。AKI是大手术中常见的并发症，且与各种不良影响相关。该研究旨在探讨在这一特定背景下AKI与其他合并症之间的关系。
方法 这是一项回顾性队列研究。所有在阿卜杜勒阿齐兹国王医疗城（KAMC）腹部创伤后接受剖腹手术且符合纳入标准的患者均纳入本研究。采用非概率连续抽样。通过使用KAMC的最佳护理系统进行病历审查来收集数据。使用描述性统计来总结和描述研究参与者的特征。计算分类变量（如合并症）的频率和百分比。对于连续变量，计算均值和标准差并制成表格。所有统计计算均使用IBM SPSS Statistics for Windows，版本27.0（IBM公司，美国纽约州阿蒙克）进行。
结果 本研究纳入了152例接受剖腹手术的患者，大多数患者（146例，96%）未发生AKI。观察到几种合并症，其中高血压和糖尿病最为常见，分别为37例（24.3%）和35例（23%）。23例（15.1%）患者术中出现低血压，而129例（84.9%）患者未出现此问题。去甲肾上腺素是最常用的血管升压药（25.7%），其次是麻黄碱以及去甲肾上腺素和肾上腺素的联合使用。性别和年龄组与AKI无显著关联，而糖尿病、心力衰竭和慢性肾脏病（CKD）等合并症与AKI存在显著关系。符合AKI标准的患者与未符合标准的患者之间的估算肾小球滤过率（eGFR）和血清肌酐基线水平无显著差异。
结论 该患者群体中AKI的总体发病率较低，令人鼓舞。然而，医疗保健专业人员必须意识到糖尿病、心力衰竭和CKD等合并症对AKI发生发展的重大影响。对术后肾功能进行密切监测，尤其是术后48小时内的血清肌酐水平，对于早期发现和及时干预至关重要。通过了解和应对这些风险因素，医疗保健提供者可以采取积极措施预防和管理接受剖腹手术患者的AKI，最终改善患者预后并降低医疗成本。
