Department of Anesthesiology, Peking University First Hospital, Beijing, China.
Department of Anesthesiology, Aerospace Center Hospital, Beijing, China.
Ren Fail. 2024 Dec;46(2):2420835. doi: 10.1080/0886022X.2024.2420835. Epub 2024 Nov 4.
Acute kidney injury (AKI) is common after cytoreduction surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for peritoneal surface malignancies. Herein we analyzed the association between intraoperative hyperthermia and AKI following CRS-HIPEC.
In this retrospective cohort study, we collected baseline and perioperative data from patients who underwent CRS-HIPEC mainly for pseudomyxoma peritonei between 2014 and 2020. Nasopharyngeal temperature was recorded at 5-min intervals. The area above the threshold was calculated for intraoperative hyperthermia (>37.0 °C). AKI was diagnosed and classified according to the KDIGO creatinine criteria. A multivariable logistic regression model was established to assess the association between hyperthermia and AKI.
A total of 480 patients were included in the analysis. Of these, 10.6% (51/480) developed AKI within 7 postoperative days. After correction for confounding factors, a larger area above the threshold of hyperthermia was significantly associated with an increased risk of AKI (odds ratio [OR] 1.36, 95% CI 1.14-1.63, = 0.001). Among other factors, older age (OR 1.05, 95% CI 1.02-1.09, = 0.002), postoperative hypotension requiring vasopressors (OR 2.09, 95% CI 1.02-4.27, = 0.042), and intraperitoneal chemotherapy containing cisplatin (OR 2.75, 95% CI 1.20-6.33, = 0.017) were also associated with an increased risk of AKI. Patients with AKI required longer mechanical ventilation, stayed longer in the intensive care unit and hospital, developed more complications, and required more intensive care unit readmission.
Among patients undergoing CRS-HIPEC, intraoperative hyperthermia was independently associated with a higher risk of AKI; this effect was additive to other risk factors including cisplatin-containing chemotherapy.
细胞减灭术和腹腔热灌注化疗（CRS-HIPEC）治疗腹膜表面恶性肿瘤后常发生急性肾损伤（AKI）。在此，我们分析了 CRS-HIPEC 术中高热与 AKI 之间的关系。
本回顾性队列研究收集了 2014 年至 2020 年间行 CRS-HIPEC 治疗主要为假性黏液瘤的患者的基线和围手术期数据。每隔 5 分钟记录鼻咽温度。计算术中高热（>37.0°C）的阈值上面积。根据 KDIGO 肌酐标准诊断和分级 AKI。建立多变量逻辑回归模型评估高热与 AKI 之间的关系。
共纳入 480 例患者，其中 10.6%（51/480）在术后 7 天内发生 AKI。校正混杂因素后，较大的高热阈值上面积与 AKI 风险增加显著相关（比值比 [OR] 1.36，95%CI 1.14-1.63， = 0.001）。在其他因素中，年龄较大（OR 1.05，95%CI 1.02-1.09， = 0.002）、术后低血压需用升压药（OR 2.09，95%CI 1.02-4.27， = 0.042）和含顺铂的腹腔化疗（OR 2.75，95%CI 1.20-6.33， = 0.017）也与 AKI 风险增加相关。发生 AKI 的患者需要更长时间的机械通气，在 ICU 和医院停留时间更长，发生更多并发症，需要更多的 ICU 再入院。
在接受 CRS-HIPEC 的患者中，术中高热与 AKI 风险增加独立相关；这种作用与包括含顺铂化疗在内的其他危险因素相加。
