Yıldırım Güçlü Çiğdem, Karadağ Erkoç Süheyla, Şafak Bengi, Kahya Yusuf, Güneş Süleyman Gökalp, Meco Başak Ceyda
Department of Anaesthesiology and Intensive Care Medicine, Ankara University Faculty of Medicine, Ankara, Türkiye.
Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Türkiye.
Thorac Res Pract. 2026 Jan 30;27(1):21-29. doi: 10.4274/ThoracResPract.2025.2025-7-9.
Acute kidney injury (AKI) is a significant postoperative complication of thoracic surgery, but data on AKI after pneumonectomy remain scarce. This study aimed to determine the incidence, risk factors, and short-term outcomes of AKI, as defined by Kidney Disease Improving Global Outcomes 2012 criteria, occurring within one week after pneumonectomy.
This retrospective single-center cohort included adults who underwent elective pneumonectomy between 2008-2018. Patients with preoperative chronic kidney disease or AKI, or with missing data, were excluded. Demographic, perioperative, and postoperative data were collected from hospital records. AKI was identified based on postoperative creatinine values measured within one week. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors.
Of the 308 patients, 166 met the inclusion criteria. The incidence of AKI was 12% (19 stage 1, 1 stage 2); none required renal replacement therapy. In multivariate analysis, increased body mass index [odds ratio (OR): 1.10, 95% confidence interval (CI): 1.01-1.21, = 0.038]; acetylsalicylic acid use (OR: 10.56, 95% CI: 1.58-70.60, = 0.015); higher intraoperative fluid volume (OR: 1.00, 95% CI: 1.00-1.00, = 0.036); and length of stay (OR: 1.07, 95% CI: 1.01-1.13, = 0.016) were associated with increased AKI risk, while nonsteroidal anti-inflammatory drug use was independently protective (OR: 0.03, 95% CI: 0.00-0.13, < 0.001), as was diuretic use (OR: 0.06, 95% CI: 0.01-0.50, = 0.009). AKI was associated with longer hospitalization but not with increased mortality.
Reducing the incidence of AKI may improve patient outcomes, and AKI should be considered a key quality indicator in thoracic surgery. Identifying and understanding the risk factors for AKI may provide the foundation for predictive models and guide strategies to prevent this complication.
急性肾损伤（AKI）是胸外科手术后的一种重要并发症，但肺切除术后AKI的数据仍然匮乏。本研究旨在确定根据2012年改善全球肾脏病预后组织（KDIGO）标准定义的肺切除术后1周内发生的AKI的发生率、危险因素及短期结局。
本回顾性单中心队列研究纳入了2008年至2018年间接受择期肺切除术的成年人。排除术前患有慢性肾脏病或AKI或数据缺失的患者。从医院记录中收集人口统计学、围手术期和术后数据。根据术后1周内测量的肌酐值确定AKI。进行单因素和多因素逻辑回归分析以确定独立危险因素。
308例患者中，166例符合纳入标准。AKI的发生率为12%（19例1期，1例2期）；无人需要肾脏替代治疗。多因素分析中，体重指数增加[比值比（OR）：1.10，95%置信区间（CI）：1.01 - 1.21，P = 0.038]；使用乙酰水杨酸（OR：10.56，95% CI：1.58 - 70.60，P = 0.015）；术中液体量增加（OR：1.00，95% CI：1.00 - 1.00，P = 0.036）；以及住院时间（OR：1.07，95% CI：1.01 - 1.13，P = 0.016）与AKI风险增加相关，而使用非甾体类抗炎药具有独立保护作用（OR：0.03，95% CI：0.00 - 0.13，P < 0.001），使用利尿剂也是如此（OR：0.06，95% CI：0.01 - 0.50，P = 0.009）。AKI与住院时间延长相关，但与死亡率增加无关。
降低AKI的发生率可能改善患者结局，AKI应被视为胸外科手术中的关键质量指标。识别和了解AKI的危险因素可为预测模型提供基础，并指导预防这一并发症的策略。
