Department of Anesthesiology, University of Virginia, 1 Hospital Dr, Box # 4748, 1215 Lee Street, Charlottesville, VA, 22903, USA.
School of Data Science, University of Virginia, Charlottesville, USA.
BMC Anesthesiol. 2024 Oct 31;24(1):395. doi: 10.1186/s12871-024-02784-3.
To investigate if intraoperative very short-term variability in blood pressure measured by sample entropy improves discrimination of postoperative acute kidney injury after noncardiac surgery.
Adult surgical patients undergoing general, thoracic, urological, or gynecological surgery between August 2016 to June 2017 at Seoul National University Hospital were included. The primary outcome was acute kidney injury stage 1, defined by the Kidney Disease: Improving Global Outcomes guidelines. Exploratory and explanatory variables included sample entropy of the mean arterial pressure and standard demographic, surgical, anesthesia and hypotension over time indices known to be associated with acute kidney injury respectively. Random forest classification and L1 logistic regression were used to assess four models for discriminating acute kidney injury: (1) Standard risk factors which included demographic, anesthetic, and surgical variables (2) Standard risk factors and cumulative hypotension over time (3) Standard risk factors and sample entropy (4) Standard risk factors, cumulative hypotension over time and sample entropy.
Two hundred and thirteen (7.4%) cases developed postoperative acute kidney injury. The median and interquartile range for sample entropy of mean arterial pressure was 0.34 and [0.26, 0.42] respectively. C-statistics were identical between the random forest and L1 logistic regression models. Results demonstrated no improvement in discrimination of postoperative acute kidney injury with the addition of the sample entropy of mean arterial pressure: Standard risk factors: 0.81 [0.76, 0.85], Standard risk factors and hypotension over time indices: 0.80 [0.75, 0.85], Standard risk factors and sample entropy of mean arterial pressure: 0.81 [0.76, 0.85] and Standard risk factors, sample entropy of mean arterial pressure and hypotension over time indices: 0.81 [0.76, 0.86].
Assessment of very short-term blood pressure variability does not improve the discrimination of postoperative acute kidney injury in patients undergoing non-cardiac surgery in this sample.
研究术中通过样本熵测量的血压短期变异性是否能提高非心脏手术后术后急性肾损伤的鉴别能力。
纳入 2016 年 8 月至 2017 年 6 月在首尔国立大学医院接受普通、胸科、泌尿科或妇科手术的成年手术患者。主要结局为急性肾损伤 1 期，定义为肾脏病：改善全球预后指南。探索性和解释性变量包括平均动脉压的样本熵和标准人口统计学、手术、麻醉和低血压随时间变化的指数，这些指数分别与急性肾损伤相关。随机森林分类和 L1 逻辑回归用于评估四个鉴别急性肾损伤的模型：（1）标准危险因素，包括人口统计学、麻醉和手术变量；（2）标准危险因素和随时间推移的累积低血压；（3）标准危险因素和样本熵；（4）标准危险因素、随时间推移的累积低血压和样本熵。
213 例（7.4%）患者术后发生急性肾损伤。平均动脉压样本熵的中位数和四分位距分别为 0.34 和 [0.26, 0.42]。随机森林和 L1 逻辑回归模型的 C 统计量相同。结果表明，增加平均动脉压样本熵并不能提高术后急性肾损伤的鉴别能力：标准危险因素：0.81 [0.76, 0.85]，标准危险因素和低血压随时间变化的指数：0.80 [0.75, 0.85]，标准危险因素和平均动脉压样本熵：0.81 [0.76, 0.85]，标准危险因素、平均动脉压样本熵和低血压随时间变化的指数：0.81 [0.76, 0.86]。
在本样本中，评估短期血压变异性并不能提高非心脏手术患者术后急性肾损伤的鉴别能力。
