Zhou Ran, Wang Huan, Yang Qi, Han Lin
Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Department of Neurology, West China School of Public Health and West China Forth Hospital, Sichuan University, Chengdu, China.
Front Physiol. 2025 Jul 8;16:1614336. doi: 10.3389/fphys.2025.1614336. eCollection 2025.
Acute kidney injury (AKI) is one of the most common complications after liver transplantation (LT). Few studies have focused on the risk factors for severe AKI (KDIGO criteria: stage 3) after LT. The aim of this study was to identify critical determinants associated with the progression to severe AKI in LT patients admitted to the intensive care unit (ICU).
This retrospective case-control study analyzed data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) datasets, version 3.1. Patients were categorized into two groups according to the stage of AKI. Patients diagnosed with AKI stage I or II were placed in the mild-AKI group, and the others diagnosed with AKI stage Ⅲ were placed in the severe-AKI group. Risk factors were figured out through the univariate and multivariable logistic regression models between the groups. Restricted cubic spline (RCS) analyses were conducted to determine threshold effects of the identified risk factors on severe AKI.
A total of 251 patients were enrolled. A total of 131 patients were diagnosed with AKI stage I or II (mild-AKI group), whereas 120 patients were diagnosed with AKI stage Ⅲ (severe-AKI group). Multivariable logistic regression analysis revealed that gender (female), total bilirubin, serum creatinine, and Simplified Acute Physiology Score II (SAPS II) were independent risk factors for severe AKI in LT patients. Male patients had a significantly lower risk of severe AKI than female patients (p = 0.023; OR = 0.349; 95% CI: 0.138-0.854). RCS analysis further revealed nonlinear associations with critical inflection points at total bilirubin 12.189 mg/dL, serum creatinine 1.118 mg/dL, and SAPS-II of 42. Beyond these thresholds, each incremental increase in these parameters demonstrated a statistically significant escalation in severe-AKI risk.
In our study, we found that gender (female), total bilirubin (≥12.189 mg/dL), creatinine (≥1.118 mg/dL), and SAPS-II (≥42) are the independent risk factors for severe AKI in patients after LT.
急性肾损伤（AKI）是肝移植（LT）后最常见的并发症之一。很少有研究关注LT后严重AKI（KDIGO标准：3期）的危险因素。本研究的目的是确定入住重症监护病房（ICU）的LT患者进展为严重AKI的关键决定因素。
这项回顾性病例对照研究分析了重症监护医学信息数据库-IV（MIMIC-IV）数据集3.1版中的数据。根据AKI分期将患者分为两组。诊断为AKI I期或II期的患者归入轻度AKI组，其他诊断为AKI III期的患者归入重度AKI组。通过两组之间的单变量和多变量逻辑回归模型找出危险因素。进行限制立方样条（RCS）分析以确定已识别的危险因素对严重AKI的阈值效应。
共纳入251例患者。共有131例患者被诊断为AKI I期或II期（轻度AKI组），而120例患者被诊断为AKI III期（重度AKI组）。多变量逻辑回归分析显示，性别（女性）、总胆红素、血清肌酐和简化急性生理学评分II（SAPS II）是LT患者发生严重AKI的独立危险因素。男性患者发生严重AKI的风险显著低于女性患者（p = 0.023；OR = 0.349；95%CI：0.138 - 0.854）。RCS分析进一步揭示了总胆红素12.189mg/dL、血清肌酐1.118mg/dL和SAPS-II 42时存在具有临界拐点的非线性关联。超过这些阈值，这些参数的每一次增量增加都表明严重AKI风险在统计学上有显著升高。
在我们的研究中，我们发现性别（女性）、总胆红素（≥12.189mg/dL）、肌酐（≥1.118mg/dL）和SAPS-II（≥42）是LT术后患者发生严重AKI的独立危险因素。
