Xu Lingyi, Tang Linger, Zheng Xizi, Yang Li
Key Laboratory of Renal Disease, Renal Division, Ministry of Health of China, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing 100034, China.
Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Chinese Academy of Medical Sciences, Beijing 100034, China.
J Clin Med. 2024 Aug 20;13(16):4905. doi: 10.3390/jcm13164905.
: Acute kidney injury (AKI), a prevalent postoperative complication, predominantly manifests as stage 1, characterized by a mild elevation in serum creatinine (SCr). There is yet to be a consensus regarding the association between stage 1 AKI and adverse outcomes in surgical patients. This retrospective study enrolled adult patients who underwent at least one surgery during hospitalization from the MIMIC IV database. AKI was diagnosed when the KDIGO creatinine criteria were satisfied within 7 days after surgery. Stage 1a AKI was defined as an absolute increase in SCr of 26.5 μmol/L, and stage 1b was defined as a 50% relative increase. Stage 1 AKI was also divided into transient and persistent substages based on whether the AKI recovered within 48 h after onset. The association between stage 1 AKI and its substages and in-hospital mortality was evaluated. Among 49,928 patients enrolled, 9755 (19.5%) developed AKI within 7 days after surgery, of which 7659 (78.5%) presented with stage 1 AKI. The median follow-up was 369 (367, 372) days. Stage 1 AKI was significantly associated with in-hospital mortality after adjustment (aHR, 2.73; 95% CI, 2.29, 3.26). Subgroup analyses showed that the risk of stage 1 AKI on in-hospital mortality was attenuated by age ≥ 65 years ( for interaction = 0.017) or a baseline eGFR < 60 mL/min per 1.73 m ( for interaction = 0.001). Compared with non-AKI, patients with stage 1b (aHR, 3.06; 95% CI, 2.56, 3.66) and persistent stage 1 (aHR, 2.03; 95% CI, 1.61, 2.57) AKI had an increased risk of in-hospital mortality; however, this risk was not significant in those with stage 1a (aHR, 1.01; 95% CI, 0.68, 1.51) and transient stage 1 (aHR, 1.11; 95% CI, 0.79, 1.57) AKI. Stage 1 AKI exhibits an independent correlation with a heightened mortality risk among surgical patients. Consequently, a tailored adaptation of the KDIGO AKI classification may be necessitated for the surgical population, particularly those presenting with decreased baseline kidney function.
急性肾损伤（AKI）是一种常见的术后并发症，主要表现为1期，其特征是血清肌酐（SCr）轻度升高。关于1期AKI与手术患者不良结局之间的关联尚无共识。这项回顾性研究纳入了来自MIMIC IV数据库中住院期间至少接受过一次手术的成年患者。术后7天内满足KDIGO肌酐标准时诊断为AKI。1a期AKI定义为SCr绝对升高26.5μmol/L，1b期定义为相对升高50%。1期AKI还根据发病后48小时内AKI是否恢复分为短暂性和持续性亚阶段。评估了1期AKI及其亚阶段与住院死亡率之间的关联。在纳入的49928例患者中，9755例（19.5%）在术后7天内发生AKI，其中7659例（78.5%）为1期AKI。中位随访时间为369（367，372）天。调整后，1期AKI与住院死亡率显著相关（校正风险比[aHR]，2.73；95%置信区间[CI]，2.29，3.26）。亚组分析显示，年龄≥65岁（交互作用P = 0.017）或基线估算肾小球滤过率（eGFR）<60 mL/（min·1.73 m²）（交互作用P = 0.001）可减弱1期AKI对住院死亡率的风险。与非AKI相比，1b期（aHR，3.06；95%CI，2.56，3.66）和持续性1期（aHR，2.03；95%CI，1.61，2.57）AKI患者的住院死亡风险增加；然而，1a期（aHR，1.01；95%CI，0.68，1.51）和短暂性1期（aHR，1.11；95%CI，0.79，1.57）AKI患者的这种风险不显著。1期AKI与手术患者死亡风险升高存在独立相关性。因此，对于手术人群，特别是基线肾功能下降的人群，可能需要对KDIGO AKI分类进行针对性调整。
