Intraoperative oliguria predicts acute kidney injury after major abdominal surgery
Intraoperative oliguria predicts acute kidney injury after major abdominal surgery
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DOI：
10.1093/bja/aex255
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发表时间：
2017-12-01
影响因子：
9.8
通讯作者：
Kai, S.
中科院分区：
文献类型：
--
作者：
Mizota, T.;Yamamoto, Y.;Kai, S.
背景术中尿量的阈值（低于该阈值，急性肾损伤（阿基）的风险增加）尚不清楚。这项回顾性队列研究的目的是调查腹部大手术期间术中尿量与术后阿基发生之间的关系，并确定预测AKI差异风险的最佳阈值。回顾性收集了在京都大学医院接受腹部大手术（肝、结直肠、胃、胰腺或食管切除术）的3560例患者的围手术期数据。我们评估了术中尿量与最近指南定义的术后阿基发生之间的关系。进行Logistic回归分析以调整患者和手术变量，最小P值法用于确定独立改变AKI风险的术中尿量阈值。研究人群中阿基的总发生率为6.3%。使用最小P值方法，确定阈值为0.3 ml kg（-1）h（-1），低于该阈值，阿基的风险增加（调整后的比值比，2.65; 95%置信区间，1.77-3.97; P < 0.001）。将少尿< 0.3 ml kg（-1）h（-1）添加到具有传统危险因素的模型中，显著改善了阿基的危险分层（净重新分类改善，0.159; 95%置信区间，0.049-0.270; P=0.005）。在接受腹部大手术的患者中，术中少尿< 0.3 ml kg（-1）h（-1）与术后阿基风险增加显著相关。
Background. The threshold of intraoperative urine output below which the risk of acute kidney injury (AKI) increases is unclear. The aim of this retrospective cohort study was to investigate the relationship between intraoperative urine output during major abdominal surgery and the development of postoperative AKI and to identify an optimal threshold for predicting the differential risk of AKI.Methods. Perioperative data were collected retrospectively on 3560 patients undergoing major abdominal surgery (liver, colorectal, gastric, pancreatic, or oesophageal resection) at Kyoto University Hospital. We evaluated the relationship between intraoperative urine output and the development of postoperative AKI as defined by recent guidelines. Logistic regression analysis was performed to adjust for patient and operative variables, and the minimum P-value approach was used to determine the threshold of intraoperative urine output that independently altered the risk of AKI.Results. The overall incidence of AKI in the study population was 6.3%. Using the minimum P-value approach, a threshold of 0.3 ml kg(-1) h(-1) was identified, below which there was an increased risk of AKI (adjusted odds ratio, 2.65; 95% confidence interval, 1.77-3.97; P < 0.001). The addition of oliguria < 0.3 ml kg(-1) h(-1) to a model with conventional risk factors significantly improved risk stratification for AKI (net reclassification improvement, 0.159; 95% confidence interval, 0.049-0.270; P=0.005).Conclusions. Among patients undergoing major abdominal surgery, intraoperative oliguria < 0.3 ml kg(-1) h(-1) was significantly associated with increased risk of postoperative AKI.