多普勒衍生的肾功能储备在预测机器人手术患者术后急性肾损伤中的作用。
Doppler-Derived Renal Functional Reserve in the Prediction of Postoperative Acute Kidney Injury in Patients Undergoing Robotic Surgery.
机构信息
From the Department of Health Sciences, Section of Anesthesiology, and Intensive Care, University of Florence, Florence, Italy.
Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
出版信息
Anesth Analg. 2024 Jul 1;139(1):211-219. doi: 10.1213/ANE.0000000000006967. Epub 2024 Jun 17.
BACKGROUND
Postoperative acute kidney injury (PO-AKI) is a frequent complication after surgery. Various tools have been proposed to identify patients at high risk for AKI, including preoperative serum creatinine or estimated glomerular filtration rate (eGFR), urinary cell cycle arrest, and tubular damage biomarkers; however, none of these can appropriately assess AKI risk before surgery. Renal functional reserve (RFR) screened by the Doppler-derived intraparenchymal renal resistive index variation (IRRIV) test has been proposed to identify patients at risk for AKI before a kidney insult. IRRIV test has been developed in healthy individuals and previously investigated in cardiac surgery patients. This study aims to evaluate the value of the IRRIV test in identifying PO-AKI among patients undergoing robotic abdominal surgery in the Trendelenburg position for pelvic oncological disease.
METHODS
We performed a prospective, double-blinded, observational study. Preoperative baseline renal function and RFR were assessed in 53 patients with baseline eGFR >60 mL/min/1.73 m2, undergoing robotic surgery in the Trendelenburg position for pelvic oncological disease. The capability of Doppler-derived RFR in predicting PO-AKI was investigated with the area under the receiver operating characteristic curve (ROC-AUC).
RESULTS
Approximately 15.1% of patients developed AKI within the first 3 postoperative days. Thirty-one (58.5%) patients had a physiologic delta-RRI (ie, ≥0.05), while 22 (41.5%) patients did not. The ROC-AUC for PO-AKI was 0.85 (95% confidence interval [CI], 0.74-0.97; P = .007) for serum creatinine, 0.84 (95% CI, 0.71-0.96; P = .006) for eGFR, and 0.84 (95% CI, 0.78-0.91; P = .017) for delta-RRI. When combined with eGFR, the ROC-AUC for delta-RRI was 0.95 (95% CI, 0.9-1).
CONCLUSIONS
Our findings show that the preoperative assessment of Doppler-derived RFR combined with baseline renal function improves the capability of identifying patients at high risk for PO-AKI with eGFR >60 mL/min/1.73 m2 after robotic abdominal surgery in Trendelenburg position for pelvic oncological disease.
背景
术后急性肾损伤（PO-AKI）是手术后常见的并发症。已经提出了各种工具来识别发生 AKI 风险较高的患者，包括术前血清肌酐或估算肾小球滤过率（eGFR）、尿细胞周期停滞和肾小管损伤生物标志物；然而，这些方法均不能在术前适当评估 AKI 风险。通过多普勒衍生的肾内阻力指数变化（IRRIV）测试筛选出的肾功能储备（RFR）已被提出用于在肾脏损伤前识别发生 AKI 的风险。IRRIV 测试已经在健康个体中进行了开发，并已在心脏手术患者中进行了研究。本研究旨在评估 IRRIV 测试在识别接受机器人腹部手术的骨盆肿瘤疾病患者发生 PO-AKI 方面的价值，这些患者采用特伦德伦伯格体位。
方法
我们进行了一项前瞻性、双盲、观察性研究。在 53 名基线 eGFR＞60 mL/min/1.73 m2的患者中，对其进行了术前基线肾功能和 RFR 评估，这些患者接受了用于骨盆肿瘤疾病的机器人手术，采用特伦德伦伯格体位。使用接受者操作特征曲线（ROC）下面积（AUC）来研究多普勒衍生的 RFR 预测 PO-AKI 的能力。
结果
约 15.1%的患者在术后 3 天内发生 AKI。31 名（58.5%）患者的生理性 delta-RRI（即，≥0.05），而 22 名（41.5%）患者的 delta-RRI ＜0.05。对于发生 PO-AKI，血清肌酐的 ROC-AUC 为 0.85（95%CI，0.74-0.97；P=0.007），eGFR 的 ROC-AUC 为 0.84（95%CI，0.71-0.96；P=0.006），delta-RRI 的 ROC-AUC 为 0.84（95%CI，0.78-0.91；P=0.017）。当与 eGFR 联合时，delta-RRI 的 ROC-AUC 为 0.95（95%CI，0.9-1）。
结论
我们的研究结果表明，术前多普勒衍生的 RFR 评估与基线肾功能相结合，可以提高识别接受特伦德伦伯格体位下机器人腹部手术骨盆肿瘤疾病患者发生 PO-AKI 的风险的能力，这些患者的 eGFR＞60 mL/min/1.73 m2。
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