Effects of acute kidney injury after liver resection on long-term outcomes.
Effects of acute kidney injury after liver resection on long-term outcomes.
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DOI：
10.4097/kjae.2017.70.5.527
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发表时间：
2017-10
影响因子：
2.9
通讯作者：
Makita K
中科院分区：
文献类型：
--
作者：
Ishikawa S;Tanaka M;Maruyama F;Fukagawa A;Shiota N;Matsumura S;Makita K
研究肝切除术后急性肾损伤（阿基）对长期结局的影响，包括出院后的死亡率和肾功能不全。我们对2004年1月至2011年10月期间在七氟烷麻醉下接受肝细胞癌肝切除术的患者进行了一项历史队列研究，这些患者在住院期间存活，并随访至少3年或在出院后3年内死亡。术后72小时内根据急性肾损伤网络分类诊断为阿基。除了住院期间获得的数据外，还收集了血清肌酐浓度数据，并在出院后估计了肾小球滤过率（GFR）。阿基患者（63%，P = 0.002）比非AKI患者（31%）更有可能在3年内达到估计GFR（eGFR）45 ml/min/1.73 m2的阈值，尽管死亡率无显著差异（33% vs. 29%）。考克斯比例风险回归分析显示，术后阿基与死亡率或eGFR <45 ml/min/1.73 m2的复合结局显著相关（风险比的95% CI，1.05-2.96，P = 0.033），但与死亡率无关（P = 0.699），死亡或eGFR 60 ml/min/1.73 m2（P =0.347）的复合结局。肝切除术后，阿基患者可能在3年内死亡或中度肾功能不全的风险较高。这些结果表明，即使在出院后，肝切除术后发生阿基的患者也可能需要长期随访肾功能。
To investigate the effects of acute kidney injury (AKI) after liver resection on the long-term outcome, including mortality and renal dysfunction after hospital discharge. We conducted a historical cohort study of patients who underwent liver resection for hepatocellular carcinoma with sevoflurane anesthesia between January 2004 and October 2011, survived the hospital stay, and were followed for at least 3 years or died within 3 years after hospital discharge. AKI was diagnosed based on the Acute Kidney Injury Network classification within 72 hours postoperatively. In addition to the data obtained during hospitalization, serum creatinine concentration data were collected and the glomerular filtration rate (GFR) was estimated after hospital discharge. AKI patients (63%, P = 0.002) were more likely to reach the threshold of an estimated GFR (eGFR) of 45 ml/min/1.73 m2 within 3 years than non-AKI patients (31%) although there was no significant difference in mortality (33% vs. 29%). Cox proportional hazard regression analysis showed that postoperative AKI was significantly associated with the composite outcome of mortality or an eGFR of 45 ml/min/1.73 m2 (95% CI of hazard ratio, 1.05–2.96, P = 0.033), but not with mortality (P = 0.699), the composite outcome of mortality or an eGFR of 60 ml/min/1.73 m2 (P =0.347). After liver resection, AKI patients may be at higher risk of mortality or moderate renal dysfunction within 3 years. These findings suggest that even after discharge from the hospital, patients who suffered AKI after liver resection may need to be followed-up regarding renal function in the long term.