非心脏大手术后的急性肾损伤：其发生率降低了吗？
Acute kidney injury after non-cardiac major surgery: has it reduced?
作者信息
Cho Jeong Min, Kwon Soie, Yang Sunah, Park Jina, Jeong Subin, Park Sehoon, Ryu Jiwon, Kim Sejoong, Lee Jeonghwan, Lee Jung Pyo, Yoon Hyung-Jin, Kim Dong Ki, Joo Kwon Wook, Kim Yon Su, Kim Kwangsoo, Park Minsu, Lee Hajeong
机构信息
Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea.
Department of Internal Medicine, Chung-Ang University Seoul Hospital, Seoul, Republic of Korea.
出版信息
Clin Kidney J. 2024 Jun 19;17(7):sfae183. doi: 10.1093/ckj/sfae183. eCollection 2024 Jul.
BACKGROUND
It remains unclear whether the incidence of post-operative acute kidney injury (PO-AKI) has been reduced despite the recent emphasis on its early recognition and prevention in clinical practice. We aimed to investigate the trend in the incidence of PO-AKI and to identify the associated factors affecting its changes.
METHODS
We gathered clinical data from patients who underwent non-cardiac major surgeries at three referral hospitals from 2005 to 2020. PO-AKI was defined as KDIGO AKI criteria within 7 days after surgery. Severe PO-AKI (S-PO-AKI) was defined as stage 2 or 3 AKI. The temporal change of PO-AKI was evaluated by joinpoint regression analysis and multivariable logistic regression based on a 3-year interval.
RESULTS
Among 138 235 patients, 8156 (5.9%) PO-AKI and 1127 (0.8%) S-PO-AKI occurred, respectively. The patients enrolled in recent years were older and more were women. They had more comorbidities and a higher PO-AKI risk compared with those included in past years. As time passed, the PO-AKI incidence decreased from 8.6% in 2005-07 to 5.1% in 2017-20, whereas S-PO-AKI incidence did not change (0.8% to 0.9%). In joinpoint analysis, PO-AKI incidence tended to decrease with annual percentage change (APC) of -4.2% per year [95% confidence interval (CI) -5.5% to -2.8%, -value <.001), although S-PO-AKI did not (APC 0.9%, 95% CI -1.1 to 2.9%, -value = .347). Similarly, the overall PO-AKI incidence decreased but S-PO-AKI did not, even after adjusting covariables.
CONCLUSION
The incidence of PO-AKI has decreased recently despite the increase in known risk factors; however, the incidence of S-PO-AKI has not decreased in recent years.
TRIAL REGISTRATION INFORMATION
ClinicalTrials.gov Identifier: NCT05986474. Name of registry: Development of Synthetic Medical Data Generation Technology to Predict Postoperative Complications. URL: https://classic.clinicaltrials.gov/ct2/show/NCT05986474. Date of registration: 14 August 2023. Date of enrollment of the first participant to the trial: 27 September 2022, retrospectively registered.
背景
尽管近期临床实践中强调对术后急性肾损伤（PO-AKI）的早期识别和预防，但其发病率是否有所降低仍不清楚。我们旨在调查PO-AKI发病率的趋势，并确定影响其变化的相关因素。
方法
我们收集了2005年至2020年在三家转诊医院接受非心脏大手术患者的临床数据。PO-AKI定义为术后7天内符合KDIGO急性肾损伤标准。严重PO-AKI（S-PO-AKI）定义为急性肾损伤2期或3期。基于3年间隔，通过连接点回归分析和多变量逻辑回归评估PO-AKI的时间变化。
结果
在138235例患者中，分别发生了8156例（5.9%）PO-AKI和1127例（0.8%）S-PO-AKI。近年来纳入的患者年龄更大，女性更多。与过去几年纳入的患者相比，他们有更多的合并症和更高的PO-AKI风险。随着时间的推移，PO-AKI发病率从2005 - 2007年的8.6%降至2017 - 2020年的5.1%，而S-PO-AKI发病率没有变化（从0.8%至0.9%）。在连接点分析中，PO-AKI发病率每年以-4.2%的年变化百分比（APC）呈下降趋势[95%置信区间（CI）-5.5%至-2.8%，P值<.001]，尽管S-PO-AKI并非如此（APC 0.9%，95% CI -1.1至2.9%，P值 =.347）。同样，即使调整协变量后，总体PO-AKI发病率下降但S-PO-AKI发病率未下降。
结论
尽管已知风险因素增加，但近期PO-AKI发病率有所下降；然而，近年来S-PO-AKI发病率并未下降。
试验注册信息
ClinicalTrials.gov标识符：NCT05986474。注册机构名称：用于预测术后并发症的合成医学数据生成技术的开发。网址：https://classic.clinicaltrials.gov/ct2/show/NCT05986474。注册日期：2023年8月14日。试验第一名参与者的入组日期：2022年9月27日，追溯注册。
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