Lina Jin, Rui Zhang, Xianjun Yu, Xiuqing Wu, Yingli Zhang, Yukun Huang, Yiwei Zhang, Changshun Huang, Binbin Zhu
Department of Anaesthesiology, The First Affiliated Hospital of Ningbo University, Ningbo, 315000, China.
Anaesthesia and Pain Treatment Clinic in Bund Campus, The First Affiliated Hospital of Ningbo University, Ningbo, 315000, China.
Perioper Med (Lond). 2025 Aug 12;14(1):86. doi: 10.1186/s13741-025-00573-1.
Recent trials demonstrated renoprotective effects of amino acid infusion in cardiac surgery patients, but real-world utilization patterns and outcomes across surgical specialties remain unknown. We investigated perioperative amino acid administration patterns and associated acute kidney injury (AKI) risk across different surgical populations.
Retrospective cohort study using the INSPIRE database (2011-2020) from Seoul National University Hospital. Adult patients undergoing surgery with ≥ 24-h stays were included. Amino acid preparations were identified by ATC codes, and AKI was defined by KDIGO criteria. Primary outcomes were AKI incidence and utilization patterns across surgical departments.
Among 22,972 patients, 899 (3.9%) received peri-operative amino acid preparations with an overall AKI incidence of 3.7%. Utilization varied 60-fold across departments (0.2-11.5%). Surgery-specific patterns emerged: cardiac surgery showed no AKI events in amino acid users (0/50) versus 4.2% in non-users (p = 0.267), while non-cardiac surgery demonstrated increased AKI risk with amino acid use (7.4% vs 3.4%; RR = 2.16, 95% CI 1.65-2.85, p < 0.001). Multivariable analysis confirmed amino acid use as an independent AKI predictor (OR = 2.01, 95% CI 1.52-2.60). Machine learning analysis confirmed amino acids as the strongest AKI predictor, with Random Forest achieving superior performance (AUC-ROC 0.782) and revealing significant non-linear interactions. Propensity score matching (799 pairs) confirmed the association (OR = 1.63, 95% CI 1.05-2.52, p = 0.029).
Perioperative amino acid administration demonstrates surgery-specific patterns with differential AKI associations. These findings suggest that surgery-specific factors should be considered when developing amino-acid protocols, although causality cannot be established from this observational study.
近期试验表明，氨基酸输注对心脏手术患者具有肾脏保护作用，但不同外科专业在现实中的使用模式和结果仍不明确。我们调查了不同手术人群围手术期氨基酸的使用模式及相关急性肾损伤（AKI）风险。
采用首尔国立大学医院的INSPIRE数据库（2011 - 2020年）进行回顾性队列研究。纳入住院时间≥24小时的成年手术患者。通过解剖学治疗学及化学分类代码（ATC）识别氨基酸制剂，AKI根据改善全球肾脏病预后组织（KDIGO）标准定义。主要结局为各外科科室的AKI发生率及使用模式。
在22972例患者中，899例（3.9%）接受了围手术期氨基酸制剂治疗，总体AKI发生率为3.7%。各科室使用率相差60倍（0.2% - 11.5%）。出现了特定手术模式：心脏手术中，使用氨基酸的患者未发生AKI事件（0/50），而未使用者的AKI发生率为4.2%（p = 0.267）；非心脏手术中，使用氨基酸会增加AKI风险（7.4%对3.4%；相对危险度[RR]=2.16，95%置信区间[CI] 1.65 - 2.85，p < 0.001）。多变量分析证实使用氨基酸是AKI的独立预测因素（比值比[OR]=2.01，95% CI 1.52 - 2.60）。机器学习分析证实氨基酸是最强的AKI预测因素，随机森林模型表现优异（曲线下面积[AUC-ROC]为0.782），并揭示了显著的非线性相互作用。倾向得分匹配（799对）证实了这种关联（OR = 1.63，95% CI 1.05 - 2.52，p = 0.029）。
围手术期氨基酸给药呈现出特定手术模式及不同的AKI关联。这些发现表明，在制定氨基酸方案时应考虑特定手术因素，尽管本观察性研究无法确定因果关系。
