Postoperative acute kidney injury

Park, Sun-Hee

doi:10.4097/kjae.2017.70.3.258

Cited by 74 publications

(64 citation statements)

References 89 publications

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“…The ability to predict post-LT AKI is an important issue during the period of postoperative care, including post-transplantation. The mortality and morbidity of patients with a history of postoperative AKI are significantly higher than those of patients without such history [25]. This has been proven to worsen the function of graft livers in patients with post-AKI after LT [10].…”

Section: Discussionmentioning

confidence: 99%

Predictive Impact of Modified-Prognostic Nutritional Index for Acute Kidney Injury within 1-week after Living Donor Liver Transplantation

Min¹,

Woo²,

Chae³

et al. 2020

Int. J. Med. Sci.

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Background. Acute kidney injury (AKI) is one of the common complications after living donor liver transplantation (LDLT) and is associated with increased mortality and morbidity. The prognostic nutritional index (PNI) has been used as a predictive model for postoperative complications. Here, we create a new predictive model based on the PNI and compared its predictive accuracy to other models in patients who underwent LDLT. Material and Methods: The data from 423 patients were collected retrospectively. The patients were dichotomized into the non-AKI and the AKI groups. Multivariate adjustment for significant postoperative variables based on univariate analysis was performed. A new predictive model was created using the results from logistic regression analysis, dubbed the modified-PNI model (mPNI). The area under the receiver operating characteristic curve (AUC) was generated to determine the diagnostic accuracy and cutoff value of individual models. The net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to investigate diagnostic improvement by the mPNI. Results: Fifty-four patients (12.7 %) were diagnosed with AKI within 1-week after LDLT. The mPNI had the highest predictive accuracy (AUC = 0.823). The model of end-stage liver disease (MELD) scores and PNI were 0.793 and 0.749, respectively, and the INR and serum bilirubin were 0.705 and 0.637, respectively. The differences in the AUCs were statistically significant among the mPNI, PNI, INR, and serum bilirubin. The cutoff value for mPNI was 8.7. The NRI was 10.4% and the IDI was 3.3%. Conclusions: The mPNI predicted AKI within 1-week better than other scoring systems in patients who underwent LDLT. The recommended cutoff value of mPNI is 8.7.

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Section: Discussionmentioning

confidence: 99%

Predictive Impact of Modified-Prognostic Nutritional Index for Acute Kidney Injury within 1-week after Living Donor Liver Transplantation

Min¹,

Woo²,

Chae³

et al. 2020

Int. J. Med. Sci.

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“…In cardiac surgery, sterile inflammatory response is caused by CPB, myocardial damage with ischemia/reperfusion injury, and surgical stimulation 13 . While fundamentally being a protective internal response, it progresses to a systemic inflammatory response syndrome when extensive, which is associated with major complications such as multiple organ damage and even mortality after surgery [14][15][16] . Thus, identifying patients at risk of aggravated systemic inflammation through a reliable serum biomarker would be of clinical importance in terms of accurate risk stratification and guiding tailored anti-inflammatory therapies.…”

Section: Discussionmentioning

confidence: 99%

Prognostic role of serum high mobility group box 1 concentration in cardiac surgery

Kim

Lee

et al. 2020

Sci Rep

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Outcomes of cardiac surgery are influenced by systemic inflammation. High mobility group box 1 (HMGB1), a pivotal inflammatory mediator, plays a potential role as a prognostic biomarker in cardiovascular disease. The aim of this prospective, observational study was to investigate the relationship between serum HMGB1 concentrations and composite of morbidity endpoints in cardiac surgery. Arterial blood samples for HMGB1 measurement were collected from 250 patients after anaesthetic induction (baseline) and 1 h after weaning from cardiopulmonary bypass (post-CPB). The incidence of composite of morbidity endpoints (death, myocardial infarction, stroke, renal failure and prolonged ventilator care) was compared in relation to the tertile distribution of serum HMGB1 concentrations. The incidence of composite of morbidity endpoints was significantly different with respect to the tertile distribution of post-CPB HMGB1 concentrations (p = 0.005) only, and not to the baseline. Multivariable analysis revealed post-CPB HMGB1 concentration (OR, 1.072; p = 0.044), preoperative creatinine and duration of CPB as independent risk factors of adverse outcome. Accounting for its prominent role in mediating sterile inflammation and its relation to detrimental outcome, HMGB1 measured 1 h after weaning from CPB would serve as a useful biomarker for accurate risk stratification in cardiac surgical patients and may guide tailored anti-inflammatory therapy.Despite advances in perioperative care, cardiac surgery continues to be associated with an increased risk of unfavourable outcomes 1 . In conjunction with patient-related factors, systemic inflammation has been recognized as a key factor for post-operative complications, including multi-organ failure or even death 2 . Nevertheless, studies addressing the prognostic role of non-specific serum markers of inflammation in cardiac surgery yielded conflicting results 3-5 , not to mention that indiscriminate anti-inflammatory therapies represented by using steroids did not prove to be beneficial 6 .High-mobility group box 1 (HMGB1) is an important mediator of sterile inflammatory responses in organ damage; it is either released from the nucleus of necrotic cells or actively secreted from inflammatory cells 7 . Accordingly, studies have elucidated the role of increased serum HMGB1 concentration in acute coronary syndrome, atherosclerosis, heart failure, and other cardiovascular diseases as a marker for inflammatory response and detrimental outcome [8][9][10][11] . However, no studies have examined the prognostic role of serum HMGB1 levels in cardiac surgery, while the importance of a reliable biomarker reflecting extensive systemic inflammation cannot be overemphasized in terms of accurate risk stratification and as a potential guide for selective application of therapies in that regard. This prospective, observational study aims to investigate the prognostic role of HMGB1 through identifying the relationship between serum HMGB1 concentrations and the incidence of the composite of morbidity end...

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“…Conversely, AKI seems to be a risk factor for the development of CKD . Surgery, especially intraperitoneal and emergency surgery, increases the risk for AKI . Many perioperative events—such as the use of NSAIDs, hypovolemia, hypotension, and infection—may impair renal function …”

Section: Introductionmentioning

confidence: 99%

Chronic kidney disease and acute kidney injury in arthroplasty patients over 65 years of age

Nikkinen

Nieminen

Alahuhta

et al. 2019

Acta Anaesthesiol Scand

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Background:The purpose of this study was to evaluate the prevalence of chronic kidney disease (CKD) and the incidence of perioperative acute kidney injury (AKI) in primary arthroplasty patients over 65 years of age. Risk factors, perioperative events and the outcome of surgery were evaluated.Methods: This retrospective, hospital register-based study consists of patients operated in 2014 in the area of Oulu, Finland. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula. The incidence of AKI was evaluated based on the serum creatinine criteria of the KDIGO (Kidney Disease, Improving Global Outcomes) classification. Results:Of the 807 patients, 60.8% had mildly decreased (60-89 ml/min/1.73 m 2 ) and 13.5% moderately to severely decreased eGFR (<60 ml/min/1.73 m 2 ) preoperatively. Only 33.9% of patients with an eGFR < 60 ml/min/1.73 m 2 had a diagnosis of a kidney disease. In emergencies, 46.9% of patients with an eGFR < 60 ml/ min/1.73 m 2 were deceased at the 12-month follow-up point. The measurement of postoperative sCr was not complete (477/807) and was allocated to emergencies and older patient with more comorbidities. Of those whose postoperative sCr was available, 14 (2.9%) fulfilled AKI criteria. Most of the AKI cases had a decrease in eGFR preoperatively, a diagnosed kidney disease or diabetes mellitus.Conclusions: Impairment of kidney function was common and was related to mortality in emergency arthroplasties. Measurements of postoperative sCr were allocated to high risk patients. Preoperative kidney function, kidney disease and diabetes mellitus were important determinants for perioperative AKI.

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Postoperative acute kidney injury

Cited by 74 publications

References 89 publications

Predictive Impact of Modified-Prognostic Nutritional Index for Acute Kidney Injury within 1-week after Living Donor Liver Transplantation

Predictive Impact of Modified-Prognostic Nutritional Index for Acute Kidney Injury within 1-week after Living Donor Liver Transplantation

Prognostic role of serum high mobility group box 1 concentration in cardiac surgery

Chronic kidney disease and acute kidney injury in arthroplasty patients over 65 years of age

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