Cai Wen-Tao, Zeng Xiu-Ya, Huang Yun-Shi, Chen Wei-Sheng, Chen Xiang-Jian, Xie Xian-Hai
Department of Traumatic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Acupuncture Massage & Physical Therapy, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Front Oncol. 2024 Aug 21;14:1416888. doi: 10.3389/fonc.2024.1416888. eCollection 2024.
Patients with renal insufficiency are more prone to postoperative complications (PCs). Studies have shown that minor changes in serum creatinine (SCr), immediately post-surgery, can aid in assessing patients' renal function. This study aimed to explore the relationship between the changes in SCr and PCs in patients with gastric cancer (GC).
We prospectively collected data regarding the SCr of 530 GC patients, within 2 weeks before surgery and within 24 hours after surgery in our hospital (2014-2016). The patients were divided into three groups according to the level of SCr change after surgery: reduced (<10%), normal (10%), and elevated (>10%) creatinine groups. Univariate and multivariate logistic analysis were performed to evaluate its correlation with short-term PCs in the patients. The R language was used to construct a nomogram.
83, 217, and 230 patients were assigned to the elevated, reduced, and normal SCr groups, respectively. Multivariate analysis showed that the reduced and elevated SCr groups were independently associated with the occurrence of PCs and severe postoperative complications (SPCs), respectively. Additionally, postsurgical SCr change, age, hypoalbuminemia, total gastrectomy, combined resection, and laparoscopy, were independently related to PCs. Combining the above influential factors, the predictive model can distinguish patients with PCs more reliably (c-index is 0.715).
Post-surgery, reduced SCr is a protective factor for PCs, while elevated serum creatinine is an independent risk factor for SPCs. Our nomogram can identify GC patients with high risks of PCs.
肾功能不全患者术后更易发生并发症（PCs）。研究表明，术后血清肌酐（SCr）的微小变化有助于评估患者的肾功能。本研究旨在探讨胃癌（GC）患者SCr变化与PCs之间的关系。
我们前瞻性收集了我院（2014 - 2016年）530例GC患者术前2周内及术后24小时内的SCr数据。根据术后SCr变化水平将患者分为三组：肌酐降低组（<10%）、正常组（10%）和升高组（>10%）。进行单因素和多因素逻辑回归分析以评估其与患者短期PCs的相关性。使用R语言构建列线图。
分别有83例、217例和230例患者被分配到SCr升高组、降低组和正常组。多因素分析表明，SCr降低组和升高组分别与PCs和严重术后并发症（SPCs）的发生独立相关。此外，术后SCr变化、年龄、低蛋白血症、全胃切除术、联合切除术和腹腔镜手术与PCs独立相关。结合上述影响因素，该预测模型能更可靠地鉴别PCs患者（c指数为0.715）。
术后SCr降低是PCs的保护因素，而血清肌酐升高是SPCs的独立危险因素。我们的列线图可识别PCs高风险的GC患者。
