The incidence and risk factors of acute kidney injury after hepatobiliary surgery: a prospective observational study.
The incidence and risk factors of acute kidney injury after hepatobiliary surgery: a prospective observational study.
复制标题
DOI：
10.1186/1471-2369-15-169
复制
发表时间：
2014-10-23
期刊：
影响因子：
2.3
通讯作者：
Kim HK
中科院分区：
文献类型：
--
作者：
Cho E;Kim SC;Kim MG;Jo SK;Cho WY;Kim HK
虽然腹腔内手术是与术后急性肾损伤（阿基）相关的主要手术，但其发病率、风险因素和长期肾脏结局尚不清楚。我们旨在确定肝胆外科手术后临床或亚临床阿基患者的风险因素和6个月肾脏结局。我们还评估了尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）在早期检测阿基或预测肾脏结局中的有效性。这项前瞻性观察性研究入组了接受肝胆手术的肾功能正常患者。收集尿液和血清样品用于NGAL测量。在131例患者中，10例（7.6%）发生术后阿基。术后12小时的尿NGAL是诊断阿基的最具预测性的参数（临界值，92.85 ng/mL）。根据临界值，42例（32.1%）患者诊断为亚临床阿基。临床阿基患者和亚临床阿基患者被分配至阿基组。与非AKI组相比，阿基组的终末期肝病模型和钠（MELD-Na）评分显著较高，白蛋白水平较低，术后住院时间较长。年龄较大和MELD-Na评分较高是发生术后阿基的独立危险因素。术后6个月时，阿基组的估计肾小球滤过率（eGFR）显著低于非AKI组，尽管基线eGFR无差异。在多元线性回归分析中，术后24 h最大尿NGAL水平、术中液体平衡和接受肝移植与6个月肾脏预后不良显著相关。尿NGAL可用于术后阿基的早期诊断以及预测肝胆术后6个月的肾脏结局。相当比例的患者发生亚临床阿基，与非AKI组相比，这些患者的肾脏结局更差。本文的在线版本（doi：10.1186/1471-2369-15-169）包含补充材料，可供授权用户使用。
Although intraperitoneal surgery is a major operation associated with postoperative acute kidney injury (AKI), the incidence, risk factors, and long-term renal outcome are not well known. We aimed to determine the risk factors and 6 months renal outcome in patients with clinical or subclinical AKI after hepatobiliary surgery. We also assessed the validity of urine neutrophil gelatinase-associated lipocalin (NGAL) in the early detection of AKI or prediction of renal outcome. This prospective observational study enrolled patients with normal renal function who underwent hepatobiliary surgeries. Urine and serum samples were collected for NGAL measurement. Among 131 patients, 10 (7.6%) developed postoperative AKI. Urine NGAL at 12 h postsurgery was the most predictive parameter for the diagnosis of AKI (cutoff, 92.85 ng/mL). With the cutoff value, subclinical AKI was diagnosed in 42 (32.1%) patients. Patients with clinical AKI and those with subclinical AKI were assigned to the AKI group. The AKI group had significantly higher model for end-stage liver disease and sodium (MELD-Na) score, lower albumin level, and longer hospital stay after surgery than the non-AKI group. Older age and higher MELD-Na score were independent risk factors for the development of postoperative AKI. At 6 months postsurgery, the estimated glomerular filtration rate (eGFR) in the AKI group was significantly lower than that in the non-AKI group, although the baseline eGFR was not different. In multiple linear regression analysis, the maximum urine NGAL level during 24 h postsurgery, intraoperative fluid balance, and having liver transplantation were significantly associated with a poor 6 months renal outcome. Urine NGAL was useful in the early diagnosis of postoperative AKI as well as in predicting the 6 months renal outcome after hepatobiliary surgery. A considerable proportion of patients developed subclinical AKI, and these patients showed worse renal outcome compared with the non-AKI group. The online version of this article (doi:10.1186/1471-2369-15-169) contains supplementary material, which is available to authorized users.
登录
查看更多内容
影响因子：
6.1
作者：
Heung, Michael;Wolfgram, Dawn F.;Ojo, Akinlolu O.
通讯作者：
Ojo, Akinlolu O.
影响因子：
19.6
作者：
Bouchard, Josee;Soroko, Sharon B.;Mehta, Ravindra L.
通讯作者：
Mehta, Ravindra L.
DOI：
10.3265/nefrologia.2009.29.5.5456.en.full
发表时间：
2009-01-01
期刊：
Nefrología (Madrid)
影响因子：
--
作者：
Abelha, F.;Botelho, M.;Barros, H.
通讯作者：
Barros, H.
DOI：
10.1186/cc11240
发表时间：
2012-06-21
期刊：
Critical care (London, England)
影响因子：
--
作者：
Ronco C;Kellum JA;Haase M
通讯作者：
Haase M
影响因子：
0.3
作者：
Buelow, Matthew W.;Dall, Aaron;Earing, Michael G.
通讯作者：
Earing, Michael G.