Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital.
Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Int J Surg. 2024 Feb 1;110(2):873-883. doi: 10.1097/JS9.0000000000000861.
The association between malnutrition and postoperative acute kidney injury (AKI) has not been well studied. In this study, the authors examined the association between preoperative nutritional status and postoperative AKI in older patients who underwent major abdominal surgery, as well as the predictive value of malnutrition for AKI.
The authors retrospectively included patients aged 65 or older who underwent major elective abdominal surgery. The nutritional status of the patient was evaluated using three objective nutritional indices, such as the geriatric nutritional risk index (GNRI), the prognostic nutritional index (PNI), and the controlling nutritional status (CONUT). AKI was determined using the KDIGO criteria. The authors performed logistic regression analysis to investigate the association between preoperative nutritional status and postoperative AKI, as well as the predictive value of nutritional scores for postoperative AKI.
A total of 2775 patients were included in the study, of which 707 (25.5%), 291 (10.5%), and 517 (18.6%) had moderate to severe malnutrition according to GNRI, PNI, and CONUT calculations. After surgery, 144 (5.2%) patients developed AKI, 86.1% at stage 1, 11.1% at stage 2, and 2.8% at stage 3 as determined by KDIGO criteria. After adjustment for traditional risk factors, worse nutritional scores were associated with a higher AKI risk. In addition to traditional risk factors, these nutritional indices improved the predictive ability of AKI prediction models, as demonstrated by significant improvements in integrated discrimination and net reclassification.
Poor preoperative nutritional status, as assessed by GNRI, PNI, and CONUT scores, was associated with an increased risk of postoperative AKI. Incorporating these scores into AKI prediction models improved their performance. These findings emphasize the need for screening surgical patients for malnutrition risk. Further research is needed to determine whether preoperative malnutrition assessment and intervention can reduce postoperative AKI incidence.
营养不良与术后急性肾损伤（AKI）之间的关联尚未得到充分研究。在这项研究中，作者检查了接受大腹部手术的老年患者术前营养状况与术后 AKI 之间的关系，以及营养不良对 AKI 的预测价值。
作者回顾性纳入了年龄在 65 岁或以上、接受大择期腹部手术的患者。患者的营养状况使用三种客观营养指数进行评估，如老年营养风险指数（GNRI）、预后营养指数（PNI）和控制营养状态（CONUT）。AKI 采用 KDIGO 标准确定。作者进行逻辑回归分析，以探讨术前营养状况与术后 AKI 之间的关系，以及营养评分对术后 AKI 的预测价值。
共纳入 2775 例患者，其中根据 GNRI、PNI 和 CONUT 计算，707 例（25.5%）、291 例（10.5%）和 517 例（18.6%）存在中重度营养不良。术后 144 例（5.2%）患者发生 AKI，根据 KDIGO 标准，86.1%为 1 期，11.1%为 2 期，2.8%为 3 期。在调整传统危险因素后，营养评分越差，AKI 风险越高。除传统危险因素外，这些营养指数改善了 AKI 预测模型的预测能力，综合判别能力和净重新分类均有显著提高。
GNRI、PNI 和 CONUT 评分评估的术前营养状况较差与术后 AKI 风险增加相关。将这些评分纳入 AKI 预测模型可提高其性能。这些发现强调了对手术患者进行营养不良风险筛查的必要性。需要进一步研究以确定术前营养不良评估和干预是否可以降低术后 AKI 的发生率。
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