Acute Kidney Injury after Major Abdominal Surgery: A Retrospective Cohort Analysis

Abstract

Background. We analyzed the incidence, risk factors, and prognosis of acute kidney injury (AKI) in a cohort of patients undergoing major abdominal surgery. Methods. A total of 450 patients were retrospectively studied. AKI was defined by an increase in serum creatinine (SCr) ≥ 0.3 mg/dl or by an increase in SCr ≥ 50% and/or by a decrease in urine output to 0.5 ml/kg/hour for 6 hours, in the first 48 hours after surgery. Logistic regression method was used to determine predictors of AKI and in-hospital mortality. A two-tailed P value <0.05 was considered significant. Results. One hundred one patients (22.4%) had postoperative AKI. Age (adjusted odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01–1.05), nonrenal Revised Cardiac Risk Index score (adjusted OR 1.9, 95% CI 1.3–3.1, P = 0.003), intraoperative erythrocytes transfusions (adjusted OR 2.2, 95% CI 1.4–3.5, P <.0001), and nonrenal Simplified Acute Physiology Score II (adjusted OR 1.03, 95% CI 1.01–1.06, P = 0.0191) were associated with postoperative AKI. AKI was associated with increased in-hospital mortality (20.8% versus 2.3%, P <.0001; unadjusted OR 11.2, 95% CI 4.8–26.2, P <.0001; adjusted OR 3.7, 95% CI 1.2–11.7, P = 0.024). Conclusion. AKI was common in patients undergoing major abdominal surgery and was associated with in-hospital mortality.

Acute Kidney Injury After Abdominal Surgery: Incidence, Risk Factors, and Outcome

“…[2][3][4] In our study, AKI after abdominal surgery had a negative impact on 30-day mortality, which was 18.2% in the AKI patients compared with 5.3% in the propensity score-matched control group. This is consistent with studies by both Teixeira et al 16 and Kheterpal et al, 15 who observed a rate of 20.8% and 15%, respectively. Furthermore, Kim et al 13 described a rather higher 30-day mortality of 31% of patients with AKI after nonvascular intra-abdominal surgery.…”

“…However, direct comparison of these studies and the present one is difficult, as AKI was defined as an elevation of SCr >176.8 μmol/L above baseline or requirement for renal replacement therapy within 30 days after surgery in the previous studies. Interestingly, Teixeira et al 16 examined postoperative AKI after abdominal surgery using the KDIGO criteria and found an incidence of 22.4%, which is approximately 10-fold higher than the overall rate in our study. The difference between studies is most likely explained by limiting the inclusion to patients undergoing major surgery in a tertiary care setting and who were predicted to stay in hospital for at least 48 hours.…”

“…Several pre-and perioperative risk factors for developing AKI after abdominal surgery have been reported, including age, obesity, hypertension, COPD, elevated preoperative SCr level, and more Revised Cardiac Risk Index risk factors, although studies have yielded somewhat discordant results. 13,15,16,30 After multivariate adjustment, female sex, hypertension, preoperative CKD, ASA physical status classification of IV or V, and reoperation were identified as independent risk factors for AKI. The strong association of the commonly used perioperative mortality and cardiac morbidity risk indices with AKI is of special interest and further demonstrates their usefulness in the overall perioperative risk assessment.…”

“…(Anesth Analg 2016;122:1912-20) that exist on AKI after abdominal surgery have shown a difference in frequency ranging from 0.8% to 22.4%. 13,15,16 This variability is likely related to differences in case mix in between studies but also discrepancies between diagnostic criteria for AKI. In addition, risk factors for AKI in this cohort of patients are poorly defined.…”

Diagnostic Value of Matrix Metalloproteinase-9 and Tissue Inhibitor of Matrix Metalloproteinase-1 in Sepsis-Associated Acute Kidney Injury

“…Sepsis-associated AKI (SA-AKI) is even considered as a distinct subtype of AKI due to its unique pathophysiology (Alobaidi et al 2015). AKI is also a serious complication in surgical patients with major abdominal surgery and sepsis as some of the most important risk factors (Kheterpal et al 2009;Teixeira et al 2014).…”