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Marka AW, Luitjens J, Gassert FT, Steinhelfer L, Burian E, Rübenthaler J, Schwarze V, Froelich MF, Makowski MR, Gassert FG. Artificial intelligence support in MR imaging of incidental renal masses: an early health technology assessment. Eur Radiol 2024; 34:5856-5865. [PMID: 38388721 PMCID: PMC11364579 DOI: 10.1007/s00330-024-10643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE This study analyzes the potential cost-effectiveness of integrating an artificial intelligence (AI)-assisted system into the differentiation of incidental renal lesions as benign or malignant on MR images during follow-up. MATERIALS AND METHODS For estimation of quality-adjusted life years (QALYs) and lifetime costs, a decision model was created, including the MRI strategy and MRI + AI strategy. Model input parameters were derived from recent literature. Willingness to pay (WTP) was set to $100,000/QALY. Costs of $0 for the AI were assumed in the base-case scenario. Model uncertainty and costs of the AI system were assessed using deterministic and probabilistic sensitivity analysis. RESULTS Average total costs were at $8054 for the MRI strategy and $7939 for additional use of an AI-based algorithm. The model yielded a cumulative effectiveness of 8.76 QALYs for the MRI strategy and of 8.77 for the MRI + AI strategy. The economically dominant strategy was MRI + AI. Deterministic and probabilistic sensitivity analysis showed high robustness of the model with the incremental cost-effectiveness ratio (ICER), which represents the incremental cost associated with one additional QALY gained, remaining below the WTP for variation of the input parameters. If increasing costs for the algorithm, the ICER of $0/QALY was exceeded at $115, and the defined WTP was exceeded at $667 for the use of the AI. CONCLUSIONS This analysis, rooted in assumptions, suggests that the additional use of an AI-based algorithm may be a potentially cost-effective alternative in the differentiation of incidental renal lesions using MRI and needs to be confirmed in the future. CLINICAL RELEVANCE STATEMENT These results hint at AI's the potential impact on diagnosing renal masses. While the current study urges careful interpretation, ongoing research is essential to confirm and seamlessly integrate AI into clinical practice, ensuring its efficacy in routine diagnostics. KEY POINTS • This is a model-based study using data from literature where AI has been applied in the diagnostic workup of incidental renal lesions. • MRI + AI has the potential to be a cost-effective alternative in the differentiation of incidental renal lesions. • The additional use of AI can reduce costs in the diagnostic workup of incidental renal lesions.
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Affiliation(s)
- Alexander W Marka
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Institut für diagnostische und interventionelle Radiologie, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Johanna Luitjens
- Department of Radiology, Klinikum Großhadern, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, Munich, Germany
| | - Florian T Gassert
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Institut für diagnostische und interventionelle Radiologie, Ismaninger Str. 22, 81675, Munich, Germany
| | - Lisa Steinhelfer
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Institut für diagnostische und interventionelle Radiologie, Ismaninger Str. 22, 81675, Munich, Germany
| | - Egon Burian
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Institut für diagnostische und interventionelle Radiologie, Ismaninger Str. 22, 81675, Munich, Germany
| | - Johannes Rübenthaler
- Department of Radiology, Klinikum Großhadern, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, Munich, Germany
| | - Vincent Schwarze
- Department of Radiology, Klinikum Großhadern, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, Munich, Germany
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Institut für diagnostische und interventionelle Radiologie, Ismaninger Str. 22, 81675, Munich, Germany
| | - Felix G Gassert
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Institut für diagnostische und interventionelle Radiologie, Ismaninger Str. 22, 81675, Munich, Germany
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Choi J, Ryu DK, Woo S, Kim J, Lee S, Park B, Jeon K, Park M. The association of withholding or continuing angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers on acute kidney injury after non-cardiac surgery. Anaesthesia 2024; 79:937-944. [PMID: 38740570 DOI: 10.1111/anae.16308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Withholding or continuing angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers peri-operatively in non-cardiac surgery remains controversial as they may result in intra-operative hypotension and postoperative organ damage. METHODS We included patients prescribed angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers who underwent surgical procedures > 1 h duration under general or spinal anaesthesia from January 2012 to June 2022 in a single centre. We categorised patients by whether these drugs were withheld for 24 h before surgery. We evaluated the association of withholding these drugs before non-cardiac surgery with creatinine concentrations that increased ≥ 26.4 μmol.l-1 in the first 48 postoperative hours (acute kidney injury). We also analysed changes in creatinine concentrations and estimated glomerular filtration rates. RESULTS Angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers were withheld in 24,285 of 32,933 (74%) patients and continued in 8648 (26%) patients. We used propensity scores for drug discontinuation to match 8631 patient pairs who did or did not continue these drugs: acute kidney injury was recorded for 1791 (21%) patients who continued these drugs vs. 1587 (18%) who did not (OR (95%CI) 1.16 (1.08-1.25), p < 0.001). Intra-operative hypotension was recorded for 3892 (45%) patients who continued drugs vs. 3373 (39%) patients who did not (OR (95%CI) 1.28 (1.21-1.36), p < 0.001). Continuing drugs was independently associated with a mean increase in creatinine of 2.2 μmol.l-1 (p < 0.001) and a mean decrease in estimated glomerular filtration rate of 1.4 ml.min.1.73 m-2 (p < 0.001). CONCLUSIONS Continuing angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers 24 h before non-cardiac surgery was associated with intra-operative hypotension and postoperative acute kidney injury.
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Affiliation(s)
- Jisun Choi
- Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dae Kyun Ryu
- Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seunghyeon Woo
- Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeayoun Kim
- Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seungwon Lee
- Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Boram Park
- Biomedical Statistics Centre, Research Institute for Future Medicine, Samsung Medical Centre, Seoul, South Korea
| | - Kyeongman Jeon
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - MiHye Park
- Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Mortensen SØ, Bolther Pælestik M, Lind PC, Holmberg MJ, Granfeldt A, Stankovic N, Andersen LW. Characteristics and outcomes for general anesthesia in Denmark. Acta Anaesthesiol Scand 2024; 68:888-897. [PMID: 38767280 DOI: 10.1111/aas.14442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND General anesthesia is common, but concerns regarding post-operative complications and mortality remain. No study has described the Danish patient population undergoing general anesthesia on a national level. The aim of this study was to describe the characteristics and outcomes of patients undergoing general anesthesia in Denmark. METHODS This study was a registry-based observational cohort study of adult patients (≥18 years) undergoing general anesthesia in Denmark during 2020 and 2021. Data from nationwide registries covering patient characteristics, anesthesia and procedure information, and patient outcomes were combined. Descriptive statistics were used to present findings, both overall and in subgroups based on the American Society of Anesthesiologists (ASA) classification. RESULTS We identified 453,133 cases of general anesthesia in 328,951 unique patients. The median age was 57 years (quartiles: 41, 71), and 242,679 (54%) were females. Data on ASA classification were missing for less than 1% of the population, and ASA II was the most prevalent ASA classification (49%). Among cases of general anesthesia, 0.1% experienced a stroke, 0.2% had in-hospital cardiac arrest, and 3.9% had a stay in the intensive care unit within 30 days. Mortality at 30 days and 1 year were 1.8% and 6.3%, respectively, increasing with a higher ASA classification. CONCLUSION This study offers the first comprehensive overview of adult patients undergoing general anesthesia in Denmark. Post-anesthesia complications were few and increased with ASA classification.
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Affiliation(s)
- Signe Østergaard Mortensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Bolther Pælestik
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Carøe Lind
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Mathias Johan Holmberg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Asger Granfeldt
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Nikola Stankovic
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Wiuff Andersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Prehospital Emergency Medical Services, Central Denmark Region, Denmark
- Department of Anesthesiology and Intensive Care, Viborg Hospital, Viborg, Denmark
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Brusasco C, Cucciolini G, Barberis A, Introini C, Campodonico F, Corradi F. Improving Patient Outcomes in Abdominal Surgery. J Clin Med 2024; 13:1993. [PMID: 38610756 PMCID: PMC11012594 DOI: 10.3390/jcm13071993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024] Open
Abstract
Post-operative acute kidney injury (PO-AKI) is a frequent complication described in 15% of non-cardiac surgeries, 30% of cardiac surgeries, and 52% of patients requiring intensive post-operative care [...].
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Affiliation(s)
- Claudia Brusasco
- Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy;
| | - Giada Cucciolini
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (G.C.); (F.C.)
| | - Andrea Barberis
- General and Epatobiliar Surgery, E.O. Ospedale Galliera, 16128 Genoa, Italy;
| | - Carlo Introini
- Urology Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy;
| | | | - Francesco Corradi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (G.C.); (F.C.)
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Prowle JR, Croal B, Abbott TEF, Cuthbertson BH, Wijeysundera DN. Cystatin C or creatinine for pre-operative assessment of kidney function and risk of post-operative acute kidney injury: a secondary analysis of the METS cohort study. Clin Kidney J 2024; 17:sfae004. [PMID: 38269033 PMCID: PMC10807905 DOI: 10.1093/ckj/sfae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Indexed: 01/26/2024] Open
Abstract
Background Post-operative acute kidney injury (PO-AKI) is a common surgical complication consistently associated with subsequent morbidity and mortality. Prior kidney dysfunction is a major risk factor for PO-AKI, however it is unclear whether serum creatinine, the conventional kidney function marker, is optimal in this population. Serum cystatin C is a kidney function marker less affected by body composition and might provide better prognostic information in surgical patients. Methods This was a pre-defined, secondary analysis of a multi-centre prospective cohort study of pre-operative functional capacity. Participants were aged ≥40 years, undergoing non-cardiac surgery. We assessed the association of pre-operative estimated glomerular filtration rate (eGFR) calculated using both serum creatinine and serum cystatin C with PO-AKI within 3 days after surgery, defined by KDIGO creatinine changes. The adjusted analysis accounted for established AKI risk factors. Results A total of 1347 participants were included (median age 65 years, interquartile range 56-71), of whom 775 (58%) were male. A total of 82/1347 (6%) patients developed PO-AKI. These patients were older, had higher prevalence of cardiovascular disease and related medication, were more likely to have intra-abdominal procedures, had more intraoperative transfusion, and were more likely to be dead at 1 year after surgery 6/82 (7.3%) vs 33/1265 (2.7%) (P = .038). Pre-operative eGFR was lower in AKI than non-AKI patients using both creatinine and cystatin C. When both measurements were considered in a single age- and sex-adjusted model, eGFR-Cysc was strongly associated with PO-AKI, with increasing risk of AKI as eGFR-Cysc decreased below 90, while eGFR-Cr was no longer significantly associated. Conclusions Data from over 1000 prospectively recruited surgical patients confirms pre-operative kidney function as major risk factor for PO-AKI. Of the kidney function markers available, compared with creatinine, cystatin C had greater strength of association with PO-AKI and merits further assessment in pre-operative assessment of surgical risk.
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Affiliation(s)
- John R Prowle
- Critical Care and Peri-operative Medicine Research Group, William Harvey Research Institute, Faculty of Medicine, Queen Mary University of London, London, UK
- Adult Critical Care Unit, Barts Health NHS Trust, London, UK
| | - Bernard Croal
- NHS Grampian-Clinical Biochemistry, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - Thomas E F Abbott
- Critical Care and Peri-operative Medicine Research Group, William Harvey Research Institute, Faculty of Medicine, Queen Mary University of London, London, UK
- Adult Critical Care Unit, Barts Health NHS Trust, London, UK
| | - Brian H Cuthbertson
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON,Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Thorsdottir H, Long TE, Palsson R, Sigurdsson MI. The epidemiology and outcomes of acute kidney injury following orthopaedic procedures: A retrospective cohort study. Acta Anaesthesiol Scand 2024; 68:26-34. [PMID: 37726880 DOI: 10.1111/aas.14332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is a serious complication following major surgery. This study examined the incidence and risk factors of AKI following orthopaedic surgeries in an Icelandic cohort, as well as the association between AKI and patient- and surgery-related factors. METHODS This retrospective cohort study comprised all patients 18 years and older who underwent orthopaedic surgeries at Landspitali - The National University Hospital in the years 2006-2018 with available serum creatinine (SCr) measurements adjacent to the surgery to stage AKI. AKI was defined according to SCr portion of the KDIGO criteria. Logistic regression was used to identify patient- and surgical factors related to progression of AKI and Poisson-regression was used to explore changes in incidence. RESULTS A total of 222 cases of AKI following 3208 surgeries (6.9%) were identified in the study period with a rise in the incidence by about 17% per year. Higher age (odds ratio (OR), 1.02, 95% confidence interval (CI), 1.01-1.04 per year) and underlying reduction in kidney function (OR 1.93 (1.30-2.81), 3.24 (2.08-4.96) and 4.08 (2.35-6.96) for estimated glomerular filtration rate (eGFR) of 30-59, 15-29 and <15 mL/min/1.73 m2 compared with eGFR >60 mL/min/1.73 m2 ) were associated with higher risk of AKI, but female sex was associated with decreased odds (OR = 0.73; 95% CI, 0.54-0.98). After correcting for age, sex, preoperative kidney function, emergency surgery and underlying comorbidities and frailty, there was an increased risk of long-term mortality in patients with AKI (HR 1.41, 95% CI 1.08-1.85), and patients who developed AKI also had accelerated progression of chronic kidney disease compared with patients who did not develop AKI. CONCLUSIONS The incidence of AKI following orthopaedic surgeries is increasing and is associated with adverse outcomes. It is important that elderly individuals and patients who have reduced kidney function receive adequate monitoring and surveillance in the perioperative period.
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Affiliation(s)
| | - Thorir E Long
- Division of Nephrology, Skane University Hospital, Lund, Sweden
| | - Runolfur Palsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Division of Nephrology, Internal Medicine and Emergency Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Martin I Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Division of Anesthesia and Intensive Care Medicine, Perioperative Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
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Fowler AJ, Brayne AB, Pearse RM, Prowle JR. Long-term healthcare use after postoperative complications: an analysis of linked primary and secondary care routine data. BJA OPEN 2023; 7:100142. [PMID: 37638082 PMCID: PMC10457466 DOI: 10.1016/j.bjao.2023.100142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/24/2023] [Accepted: 04/21/2023] [Indexed: 08/29/2023]
Abstract
Background Postoperative complications are associated with reduced long-term survival. We characterise healthcare use changes after sentinel postoperative complications. Methods We linked primary and secondary care records of patients undergoing elective surgery at four East London hospitals (2012-7) with at least 90 days follow-up. Complication codes (wound infection, urinary tract infection, pneumonia, new stroke, and new myocardial infarction) recorded within 90 days of surgery were identified from primary or secondary care. Outcomes were change in healthcare contact days in the 2 yr before and after surgery, and 2 yr mortality. We report rate ratios (RaR) with 95% confidence intervals and adjusted for baseline healthcare use and confounders using negative binomial regression. Results We included 49 913 patients (median age 49 yr [inter-quartile range {IQR}: 34-64]), 27 958 (56.0%) were female. Amongst 3883 (7.8%) patients with complications (median age 58 [IQR: 43-72]), there were 18.4 days per year in contact with healthcare before surgery and 25.3 days after surgery (RaR: 1.38 [1.37-1.39]). Patients without complications (median age 48 [IQR: 33-63]) had 12.3 days per year in contact with healthcare before surgery and 14.0 days after surgery (RaR: 1.14 [1.14-1.15]). The adjusted incidence rate ratio of days in contact with healthcare associated with complications was 1.67 (1.49-1.87). More patients (391; 10.1%) with complications died within 2 yr than those without (1428; 3.1%). Conclusions Patients with postoperative complications are older with greater healthcare use before surgery. However, their absolute and relative increases in healthcare use after surgery are greater than patients without complications.
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Affiliation(s)
- Alexander J. Fowler
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Chelmsford, Essex, UK
| | - Adam B. Brayne
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- University Hospitals Plymouth, Derriford Road, Plymouth, Devon, UK
| | - Rupert M. Pearse
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - John R. Prowle
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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Legrand M, Kothari R, Fong N, Palaniappa N, Boldt D, Chen LL, Kurien P, Gabel E, Sturgess-DaPrato J, Harhay MO, Pirracchio R, Bokoch MP. Norepinephrine versus phenylephrine for treating hypotension during general anaesthesia in adult patients undergoing major noncardiac surgery: a multicentre, open-label, cluster-randomised, crossover, feasibility, and pilot trial. Br J Anaesth 2023; 130:519-527. [PMID: 36925330 DOI: 10.1016/j.bja.2023.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Intraoperative hypotension is associated with postoperative complications. The use of vasopressors is often required to correct hypotension but the best vasopressor is unknown. METHODS A multicentre, cluster-randomised, crossover, feasibility and pilot trial was conducted across five hospitals in California. Phenylephrine (PE) vs norepinephrine (NE) infusion as the first-line vasopressor in patients under general anaesthesia alternated monthly at each hospital for 6 months. The primary endpoint was first-line vasopressor administration compliance of 80% or higher. Secondary endpoints were acute kidney injury (AKI), 30-day mortality, myocardial injury after noncardiac surgery (MINS), hospital length of stay, and rehospitalisation within 30 days. RESULTS A total of 3626 patients were enrolled over 6 months; 1809 patients were randomised in the NE group, 1817 in the PE group. Overall, 88.2% received the assigned first-line vasopressor. No drug infiltrations requiring treatment were reported in either group. Patients were median 63 yr old, 50% female, and 58% white. Randomisation in the NE group vs PE group did not reduce readmission within 30 days (adjusted odds ratio=0.92; 95% confidence interval, 0.6-1.39), 30-day mortality (1.01; 0.48-2.09), AKI (1.1; 0.92-1.31), or MINS (1.63; 0.84-3.16). CONCLUSIONS A large and diverse population undergoing major surgery under general anaesthesia was successfully enrolled and randomised to receive NE or PE infusion. This pilot and feasibility trial was not powered for adverse postoperative outcomes and a follow-up multicentre effectiveness trial is planned. CLINICAL TRIAL REGISTRATION NCT04789330 (ClinicalTrials.gov).
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Affiliation(s)
- Matthieu Legrand
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA; INI-CRCT Network, Nancy, France.
| | - Rishi Kothari
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA; Department of Anesthesiology and Perioperative Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicholas Fong
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA; School of Medicine, University of California, San Francisco, CA, USA
| | - Nandini Palaniappa
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | - David Boldt
- Department of Anesthesia and Perioperative Care, University of California, Los Angeles, USA
| | - Lee-Lynn Chen
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | - Philip Kurien
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | - Eilon Gabel
- Department of Anesthesia and Perioperative Care, University of California, Los Angeles, USA
| | - Jillene Sturgess-DaPrato
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | - Michael O Harhay
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | - Michael P Bokoch
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
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Yu Y, Wu H, Liu C, Zhang C, Song Y, Ma Y, Li H, Lou J, Liu Y, Cao J, Zhang H, Xu Z, Evans RG, Duan C, Mi W. Intraoperative renal desaturation and postoperative acute kidney injury in older patients undergoing liver resection: A prospective cohort study. J Clin Anesth 2023; 87:111084. [PMID: 36905791 DOI: 10.1016/j.jclinane.2023.111084] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/15/2023] [Accepted: 02/18/2023] [Indexed: 03/13/2023]
Abstract
STUDY OBJECTIVE To determine the association between intraoperative renal tissue desaturation as measured using near-infrared spectroscopy and increased likelihood of developing postoperative acute kidney injury (AKI) in older patients undergoing hepatectomy. DESIGN A multicenter prospective cohort study. SETTING The study was conducted at two tertiary hospitals in China from September 2020 to October 2021. PATIENTS 157 older patients (≥ 60 years) undergoing open hepatectomy surgery. INTERVENTIONS AND MEASUREMENTS Renal tissue oxygen saturation was continuously monitored during operation using near-infrared spectroscopy. The exposure of interest was intraoperative renal desaturation, defined as at least 20% relative decline in renal tissue oxygen saturation from baseline. The primary outcome was postoperative AKI, defined using the Kidney Disease: Improving Global Outcomes criteria according to the serum creatinine criteria. MAIN RESULTS Renal desaturation occurred in 70 of 157 patients. Postoperative AKI was observed in 23% (16/70) and 8% (7/87) of patients with versus without renal desaturation. Patients with renal desaturation were at higher risk of AKI than patients without renal desaturation (adjusted odds ratio 3.41, 95% confidence interval: 1.12-10.36, p = 0.031). Predictive performance was 65.2% sensitivity and 33.6% specificity for hypotension alone, 69.6% sensitivity and 59.7% specificity for renal desaturation alone, and 95.7% sensitivity and 26.9% specificity for combined use of hypotension and renal desaturation. CONCLUSIONS Intraoperative renal desaturation occurred in >40% in our sample of older patients undergoing liver resection and was associated with increased risk of AKI. Intraoperative near-infrared spectroscopy monitoring enhances the detection of AKI.
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Affiliation(s)
- Yao Yu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Haotian Wu
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Chang Liu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Changsheng Zhang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuxiang Song
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yulong Ma
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hao Li
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jingsheng Lou
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanhong Liu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jiangbei Cao
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Huan Zhang
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhipeng Xu
- Department of Anesthesiology, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia; Florey Institute of Neurosciences and Mental Health, University of Melbourne, Melbourne, Australia
| | - Chongyang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China.
| | - Weidong Mi
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
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10
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Association between postoperative acute kidney injury and mortality after plastic and reconstructive surgery. Sci Rep 2022; 12:20050. [PMID: 36414767 PMCID: PMC9681753 DOI: 10.1038/s41598-022-24564-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
Acute kidney injury (AKI) is a common postoperative disorder that is associated with considerable morbidity and mortality. Although the role of AKI as an independent risk factor for mortality has been well characterized in major surgeries, its effect on postoperative outcomes in plastic and reconstructive surgery has not been evaluated. This study explored the association between postoperative AKI and mortality in patients undergoing plastic and reconstructive surgery. Consecutive adult patients who underwent plastic and reconstructive surgery without end-stage renal disease (n = 7059) at our institution from January 2011 to July 2019 were identified. The patients were divided into two groups according to occurrence of postoperative AKI: 7000 patients (99.2%) in the no AKI group and 59 patients (0.8%) in the AKI group. The primary outcome was mortality during the first year, and overall mortality and 30-days mortality were also compared. After inverse probability weighting, mortality during the first year after plastic and reconstructive surgery was significantly increased in the AKI group (1.9% vs. 18.6%; hazard ratio, 6.69; 95% confidence interval, 2.65-16.85; p < 0.001). In this study, overall and 30-day mortalities were shown to be higher in the AKI group, and further studies are needed on postoperative AKI in plastic and reconstructive surgery.
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11
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Lone Z, Zhang A, Benidir T, Corrigan D, Munoz-Lopez C, Hegde P, Fung K, Fajnzylber J, Campbell RA, Ramkumar R, Murthy PB, Eltemamy M, Kaouk J, Pascal-Haber G, Almassi N, Weight CJ, Lee BH. The role of enhanced recovery after surgery protocols in the development of acute kidney injury following radical cystectomy. Urol Oncol 2022; 40:453.e1-453.e7. [DOI: 10.1016/j.urolonc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/13/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
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12
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Fowler AJ, Wan YI, Prowle JR, Chew M, Campbell D, Cuthbertson B, Wijeysundera DN, Pearse R, Abbott T. Long-term mortality following complications after elective surgery: a secondary analysis of pooled data from two prospective cohort studies. Br J Anaesth 2022; 129:588-597. [PMID: 35989114 PMCID: PMC9575043 DOI: 10.1016/j.bja.2022.06.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/24/2022] [Accepted: 06/04/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Complications after surgery affect survival and quality of life. We aimed to confirm the relationship between postoperative complications and death within 1 yr after surgery. METHODS We conducted a secondary analysis of pooled data from two prospective cohort studies of patients undergoing surgery in five high-income countries between 2012 and 2014. Exposure was any complication within 30 days after surgery. Primary outcome was death within 1 yr after surgery, ascertained by direct follow-up or linkage to national registers. We adjusted for clinically important covariates using a mixed-effect multivariable Cox proportional hazards regression model. We conducted a planned subgroup analysis by type of complication. Data are presented as mean with standard deviation (sd), n (%), and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs). RESULTS The pooled cohort included 10 132 patients. After excluding 399 (3.9%) patients with missing data or incomplete follow-up, 9733 patients were analysed. The mean age was 59 [sd 16.8] yr, and 5362 (55.1%) were female. Of 9733 patients, 1841 (18.9%) had complications within 30 days after surgery, and 319 (3.3%) died within 1 yr after surgery. Of 1841 patients with complications, 138 (7.5%) died within 1 yr after surgery compared with 181 (2.3%) of 7892 patients without complications (aHR 1.94 [95% CI: 1.53-2.46]). Respiratory failure was associated with the highest risk of death, resulting in six deaths amongst 28 patients (21.4%). CONCLUSIONS Postoperative complications are associated with increased mortality at 1 yr. Further research is needed to identify patients at risk of complications and to reduce mortality.
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Affiliation(s)
- Alexander J Fowler
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Yize I Wan
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - John R Prowle
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Michelle Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Douglas Campbell
- Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Brian Cuthbertson
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada
| | - Rupert Pearse
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tom Abbott
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK.
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13
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Chae D, Kim NY, Kim HJ, Kim TL, Kang SJ, Kim SY. A risk scoring system integrating postoperative factors for predicting early mortality after major non-cardiac surgery. Clin Transl Sci 2022; 15:2230-2240. [PMID: 35731952 PMCID: PMC9468553 DOI: 10.1111/cts.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 01/25/2023] Open
Abstract
We aimed to develop a risk scoring system for 1-week and 1-month mortality after major non-cardiac surgery, and assess the impact of postoperative factors on 1-week and 1-month mortality using machine learning algorithms. We retrospectively reviewed the medical records of 21,510 patients who were transfused with red blood cells during non-cardiac surgery and collected pre-, intra-, and postoperative features. We derived two patient cohorts to predict 1-week and 1-month mortality and randomly split each of them into training and test cohorts at a ratio of 8:2. All the modeling steps were carried out solely based on the training cohorts, whereas the test cohorts were reserved for the evaluation of predictive performance. Incorporation of postoperative information demonstrated no significant benefit in predicting 1-week mortality but led to substantial improvement in predicting 1-month mortality. Risk scores predicting 1-week and 1-month mortality were associated with area under receiver operating characteristic curves of 84.58% and 90.66%, respectively. Brain surgery, amount of intraoperative red blood cell transfusion, preoperative platelet count, preoperative serum albumin, and American Society of Anesthesiologists physical status were included in the risk score predicting 1-week mortality. Postoperative day (POD) 5 (neutrophil count × mean platelet volume) to (lymphocyte count × platelet count) ratio, preoperative and POD 5 serum albumin, and occurrence of acute kidney injury were included in the risk score predicting 1-month mortality. Our scoring system advocates the importance of postoperative complete blood count differential and serum albumin to better predict mortality beyond the first week post-surgery.
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Affiliation(s)
- Dongwoo Chae
- Department of PharmacologyYonsei University College of MedicineSeoulKorea
| | - Na Young Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research InstituteYonsei University College of MedicineSeoulKorea
| | - Hyun Joo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research InstituteYonsei University College of MedicineSeoulKorea
| | - Tae Lim Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research InstituteYonsei University College of MedicineSeoulKorea
| | - Su Jeong Kang
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research InstituteYonsei University College of MedicineSeoulKorea
| | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research InstituteYonsei University College of MedicineSeoulKorea
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14
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Mortality and costs associated with acute kidney injury following major elective, non-cardiac surgery. J Clin Anesth 2022; 82:110933. [PMID: 35933842 DOI: 10.1016/j.jclinane.2022.110933] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/15/2022] [Accepted: 07/08/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study evaluated postoperative AKI severity and its relation to short- and long-term patient outcomes. DESIGN A retrospective, single-center cohort study of patients undergoing surgery from January 2015 to May 2020. SETTING An urban, academic medical center. PATIENTS Adult patients undergoing elective, non-cardiac surgery at our institution with a postoperative length of stay (LOS) of at least 24 h were included. Patients were included in 1-year mortality analysis if their procedure occurred prior to June 2019. INTERVENTIONS None. MEASUREMENTS Postoperative AKI was identified and staged using the Kidney Disease Improving Global Outcomes definitions. The outcomes analyzed were in-hospital mortality, LOS, total cost of the surgical hospitalization, and 1-year mortality. MAIN RESULTS Of the 8887 patients studied, 648 (7.3%) had postoperative AKI. AKI was associated with severity-dependent increases in all outcomes studied. Patients with AKI had rates of in-hospital mortality of 2.0%, 3.8%, and 12.5% for stage 1, 2, and 3 AKI compared to 0.3% for patients without AKI. Mean total costs of the surgical hospitalization were $23,896 (SD $23,736) for patients without AKI compared to $33,042 (SD $27,115), $39,133 (SD $34,006), and $73,216 ($82,290) for patients with stage 1, 2, and 3 AKI, respectively. In the 6729 patients who met inclusion for 1-year mortality analysis, AKI was also associated with 1-year mortality rates of 13.9%, 19.4%, and 22.7% compared to 5.2% for patients without AKI. In multivariate models, stage 1 AKI patients still had a higher probability of 1-year mortality (OR 1.9, 95% CI 1.3-2.6, p < 0.001) in addition to $4391 of additional costs when compared to patients without AKI (95% CI $2498-$6285, p < 0.001). CONCLUSIONS All stages of postoperative AKI were associated with increased LOS, surgical hospitalization costs, in-hospital mortality, and 1-year mortality. These findings suggest that patients with even a low-grade or stage 1 AKI are at higher risk for short- and long-term complications.
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15
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Li Y, He R, Hu S, Hahn RG. Renal Water Conservation and Plasma Creatinine in Colorectal Cancer Surgery: A Single-Group Clinical Study. Front Med (Lausanne) 2022; 9:837414. [PMID: 35712088 PMCID: PMC9195291 DOI: 10.3389/fmed.2022.837414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Elevation of plasma creatinine after surgery is associated with postoperative morbidity and mortality. We studied whether lengthy surgery might induce renal conservation of water strong enough to exceed the renal capacity to excrete creatinine. Colorectal cancer surgery was performed via laparoscopy in 126 patients. Blood and urine were sampled before surgery, in the postoperative care unit, and 1 day after surgery. The Fluid Retention Index (FRI), which is a composite index of renal water conservation, was calculated. The mean FRI before surgery was 2.4, indicating that patients were well-hydrated. The FRI increased to 2.8 after surgery, and further to 3.5 on the first postoperative day. Plasma creatinine increased in 66 (52%) of the patients while plasma proteins were diluted by 15%. Patients with urinary creatinine > 8.5 mmol/L before surgery were more likely to later show elevation of plasma creatinine (68 vs. 46%, P < 0.04). The final FRI was higher in those with perioperative elevation of plasma creatinine (median 3.7 vs. 3.4; P < 0.01) and a similar difference was found for the final urinary creatinine concentration (8.5 vs. 7.2 mmol/L; P < 0.01). The gastrointestinal recovery time was prolonged when >2 L of Ringer's had been infused during the surgery. We conclude that colorectal surgery initiated a process of renal water conservation that extended into the postoperative period. The water conservation was more intense and the urinary concentration of creatinine was higher in those who had a perioperative rise in plasma creatinine.
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Affiliation(s)
- Yuhong Li
- Department of Anesthesiology, Shulan (Hangzhou) Hospital, Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Rui He
- Department of Anesthesiology, Shaoxing People's Hospital, Shaoxing, China
| | - Shuangyan Hu
- Department of Anesthesiology, Shaoxing People's Hospital, Shaoxing, China
| | - Robert G Hahn
- Research Unit, Södertälje Hospital, Södertälje, Karolinska Institutet at Danderyds Hospital (KIDS), Stockholm, Sweden
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16
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Stundner O, Myles PS. The ‘long shadow’ of perioperative complications: association with increased risk of death up to 1 year after surgery. Br J Anaesth 2022; 129:471-473. [DOI: 10.1016/j.bja.2022.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 11/17/2022] Open
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17
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Yu Y, Zhang C, Zhang F, Liu C, Li H, Lou J, Xu Z, Liu Y, Cao J, Mi W. Development and validation of a risk nomogram for postoperative acute kidney injury in older patients undergoing liver resection: a pilot study. BMC Anesthesiol 2022; 22:22. [PMID: 35026992 PMCID: PMC8756684 DOI: 10.1186/s12871-022-01566-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative acute kidney injury (AKI) is associated with poor clinical outcomes. Early identification of high-risk patients of developing postoperative AKI can optimize perioperative renal management and facilitate patient survival. The present study aims to develop and validate a nomogram to predict postoperative AKI after liver resection in older patients. METHODS A retrospective observational study was conducted involving data from 843 older patients scheduled for liver resection at a single tertiary high caseload general hospital between 2012 and 2019. The data were randomly divided into training (70%, n = 599) and validation (30%, n = 244) datasets. The training cohort was used to construct a predictive nomogram for postoperative AKI with the logistic regression model which was confirmed by a validation cohort. The model was evaluated by receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis in the validation cohort. A summary risk score was also constructed for identifying postoperative AKI patients. RESULTS Postoperative AKI occurred in 155 (18.4%) patients and was highly associated with in-hospital mortality (5.2% vs. 0.7%, P < 0.001). The six predictors selected and assembled into the nomogram included age, preexisting chronic kidney disease (CKD), non-steroidal anti-inflammatory drugs (NSAIDs) usage, intraoperative hepatic inflow occlusion, blood loss, and transfusion. The predictive nomogram performed well in terms of discrimination with area under ROC curve (AUC) in training (0.73, 95% confidence interval (CI): 0.68-0.78) and validation (0.71, 95% CI: 0.63-0.80) datasets. The nomogram was well-calibrated with the Hosmer-Lemeshow chi-square value of 9.68 (P = 0.47). Decision curve analysis demonstrated a significant clinical benefit. The summary risk score calculated as the sum of points from the six variables (one point for each variable) performed as well as the nomogram in identifying the risk of AKI (AUC 0.71, 95% CI: 0.66-0.76). CONCLUSION This nomogram and summary risk score accurately predicted postoperative AKI using six clinically accessible variables, with potential application in facilitating the optimized perioperative renal management in older patients undergoing liver resection. TRIAL REGISTRATION NCT04922866 , retrospectively registered on clinicaltrials.gov on June 11, 2021.
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Affiliation(s)
- Yao Yu
- Medical School of Chinese PLA, 28th Fuxing Road, Haidian District, Beijing, 100853, China.,Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Changsheng Zhang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Faqiang Zhang
- Medical College of Nankai University, 94th Weijin Road, Nankai District, Tianjin, 300074, China
| | - Chang Liu
- Medical School of Chinese PLA, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hao Li
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jingsheng Lou
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Zhipeng Xu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yanhong Liu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jiangbei Cao
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Weidong Mi
- Medical School of Chinese PLA, 28th Fuxing Road, Haidian District, Beijing, 100853, China. .,Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China.
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18
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Diagnostic timing dependent characteristics of acute kidney injury following hepatectomy: a retrospective historical cohort analysis. HPB (Oxford) 2021; 23:1897-1905. [PMID: 34092494 DOI: 10.1016/j.hpb.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The timing of diagnosis of post-hepatectomy acute kidney injury (AKI) has rarely been investigated. The aim of this retrospective study was to reveal the differences between AKI subtypes following hepatectomy, as classified by timing of diagnosis. METHOD Post-hepatectomy AKI was classified as very transient AKI (vtAKI; criteria satisfied by the serum creatinine value immediately after surgery) or non-transient AKI (ntAKI; all other AKI types except for vtAKI). Multivariate logistic regression analyses for both AKI types were performed separately to identify differences in known perioperative AKI risk factors. The impacts of each AKI subtype on postoperative complications, hospital stay and renal outcome at discharge were also evaluated. RESULTS AKI was diagnosed in 135 of 750 patients (18.0%); 82 and 53 patients were classified as vtAKI and ntAKI, respectively. In multivariate analysis, even among the perioperative factors associated with whole AKI, there were distinct relationships depending on vtAKI or ntAKI. Furthermore, only ntAKI was associated with postoperative complications, longer hospital stays and impaired renal function at discharge. CONCLUSIONS Based on the results of this study, future post-hepatectomy AKI studies should only include ntAKI and exclude vtAKI, as vtAKI has minimal clinical impact despite accounting for a significant proportion of AKI patients. CLINICAL TRIAL REGISTRATIONS None.
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19
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Impact of postoperative acute kidney injury in patients undergoing major gastrointestinal surgery on 1-year survival and renal outcomes: a national multicentre cohort study. BJS Open 2021; 5:6507433. [PMID: 35029656 PMCID: PMC8759520 DOI: 10.1093/bjsopen/zrab134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/23/2021] [Indexed: 01/21/2023] Open
Abstract
Background The intermediate-term impact of acute kidney injury (AKI) in patients after major gastrointestinal and liver surgery has not been well characterized. This study aimed to evaluate the 1-year mortality rate and renal outcomes associated with postoperative AKI in a national prospective cohort. Methods This prospective multicentre, observational cohort with 1-year postoperative follow-up included adults undergoing major gastrointestinal and liver surgery across the UK and Ireland between 23 September and 18 November 2015. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The primary outcome was death at 1-year after surgery, and the secondary outcome was Major Adverse Kidney Events (MAKE-365). Cox proportionate and multilevel logistic regression were used to account for case mix. Results Of 5745 patients across 173 centres, 1-year follow-up data was completed for 3504 patients (62.2 per cent, 126 centres), with attrition largely explained by centre non-participation (63.1 per cent). Some 13.6 per cent (475 of 3504) patients developed AKI by 7 days after surgery (stage 1: 9.2 per cent; stage 2/3: 4.3 per cent). At 1 year, 10.8 per cent (378 patients) experienced a MAKE-365 endpoint (303 patients had died, 61 had renal replacement therapy and 78 had renal dysfunction). Patients who experienced AKI by 7 days after surgery had a higher hazard of death at 1 year for KDIGO stage 1 (hazard ratio 1.50 (95 per cent c.i. 1.08 to 2.08), P = 0.016) and KDIGO stage 2/3 (hazard ratio 2.96 (95 per cent c.i. 2.02 to 4.33), P < 0.001). Both KDIGO stage 1 (odds ratio 2.09 (95 per cent c.i. 1.50 to 2.92), P < 0.001) and stage 2/3 (odds ratio 9.26 (95 per cent c.i. 6.31 to 13.59), P < 0.001) AKI were independently associated with MAKE-365. Conclusion AKI events within 7 days after gastrointestinal or liver surgery are associated with significantly worse survival and renal outcomes at 1 year.
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20
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Lone Z, Campbell RA, Corrigan D, Ramkumar R, Hegde P, Rahmy A, Murthy PB, Haber GP, Almassi N, Lee BH. Ability of the surgical Apgar score to predict acute kidney injury following radical cystectomy. Urol Oncol 2021; 40:194.e1-194.e6. [PMID: 34654645 DOI: 10.1016/j.urolonc.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/16/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Acute kidney injury (AKI) is a common complication after radical cystectomy (RC). Previous literature has shown that intraoperative hemodynamic instability measured via the surgical Apgar score is an independent predictor of major complications following RC. We sought to determine whether the surgical Apgar score is predictive of postoperative AKI. METHODS We performed a retrospective review of RC patients at our institution from 2010 to 2017. Intraoperative hemodynamic instability was captured via the Apgar score based on the lowest intraoperative mean arterial blood pressure, lowest heart rate, and estimated blood loss. Patients were divided into 3 groups: high-risk (HR; Apgar ≤4), intermediate-risk (IR; Apgar score 5-6), and low-risk (LR; Apgar score ≥7). AKIs were graded according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. High grade AKIs were defined as KDIGO grade 2 or 3. Categorical variables were assessed using the Pearson Chi-Square test, quantitative with the Kruskal-Wallis test, and multivariable logistic regression to identify predictors of AKI and high grade AKIs within 30 days of RC. RESULTS Eight hundred and seventy-three patients were included with a median follow-up of 35 months. AKI within 30 days was observed in 28% of patients. Predictors of AKI within 30 days on adjusted analysis included IR (OR: 1.83, P = 0.002) and HR (OR: 3.53, P < 0.001) Apgar scores. IR (OR: 2.23, P = 0.007) and HR (OR: 4.87, P < 0.001) Apgar scores were also predictors of high-grade AKIs. CONCLUSION Intraoperative hemodynamic instability measured via the Apgar score can be predictive of AKI, which can guide individualized fluid management in the postoperative period.
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Affiliation(s)
- Zaeem Lone
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH.
| | - Rebecca A Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Dillon Corrigan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Rathika Ramkumar
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Pranay Hegde
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | | | - Prithvi B Murthy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Nima Almassi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Byron H Lee
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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21
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Katayama HT, Gomes BC, Lobo SMA, Chaves RCDF, Corrêa TD, Assunção MSC, Serpa Neto A, Malbouisson LMS, Silva-Jr JM. The effects of acute kidney injury in a multicenter cohort of high-risk surgical patients. Ren Fail 2021; 43:1338-1348. [PMID: 34579622 PMCID: PMC8477947 DOI: 10.1080/0886022x.2021.1977318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Patients who develop post-operative acute kidney injury (AKI) have a poor prognosis, especially when undergoing high-risk surgery. Therefore, the objective of this study was to evaluate the outcome of patients with AKI acquired after non-cardiac surgery and the possible risk factors for this complication. METHODS A multicenter, prospective cohort study with patients admitted to intensive care units (ICUs) after non-cardiac surgery was conducted to assess whether they developed AKI. The patients who developed AKI were then compared to non-AKI patients. RESULTS A total of 29 ICUs participated, of which 904 high-risk surgical patients were involved in the study. The occurrence of AKI in the post-operative period was 15.8%, and the mortality rate of post-operative AKI patients at 28 days was 27.6%. AKI was strongly associated with 28-day mortality (OR = 2.91; 95% CI 1.51-5.62; p = 0.001), and a higher length of ICU and hospital stay (p < 0.001). Independent factors for the risk of developing AKI were pre-operative anemia (OR = 7.01; 95% CI 1.69-29.07), elective surgery (OR = 0.45; 95% CI 0.21-0.97), SAPS 3 (OR = 1.04; 95% CI 1.02-1.06), post-operative vasopressor use (OR = 2.47; 95% CI 1.34-4.55), post-operative infection (OR = 8.82; 95% CI 2.43-32.05) and the need for reoperation (OR= 7.15; 95% CI 2.58-19.79). CONCLUSION AKI was associated with the risk of death in surgical patients and those with anemia before surgery, who had a higher SAPS 3, needed a post-operative vasopressor, or had a post-operative infection or needed reoperation were more likely to develop AKI post-operatively.
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Affiliation(s)
| | | | | | | | | | | | | | | | - João Manoel Silva-Jr
- Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
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Saito T, Murakawa T, Shintani Y, Okami J, Miyaoka E, Yoshino I, Date H. Preoperative renal dysfunction and long-term survival after surgery for non-small cell lung cancer. J Thorac Cardiovasc Surg 2021; 164:227-239.e6. [PMID: 34600766 DOI: 10.1016/j.jtcvs.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/31/2021] [Accepted: 09/03/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the association of preoperative renal dysfunction and long-term outcomes following lung cancer surgery. METHODS Using the Japanese Lung Cancer Registry data, we retrospectively examined 16,377 patients who underwent surgery for non-small cell lung cancer during 2010. Patients' renal function status was categorized as follows: serum creatinine <1.5 mg/dL (control, n = 16,169), serum creatinine ≥1.5 mg/dL with no dialysis (nondialysis-dependent chronic kidney disease, n = 113), and dialysis-dependent end-stage renal disease (n = 95). The association of patients' characteristics with overall survival was evaluated using multivariate Cox proportional hazard model. RESULTS The 5-year overall survival rates in patients with dialysis-dependent end-stage renal disease and with nondialysis-dependent chronic kidney disease were significantly worse than that in the control group (52.9% and 57.5% vs 78.0%; P < .001 for both comparisons), but were comparable to the reported 5-year overall survival rates in the natural history of end-stage renal disease (∼60%) and moderate to severe chronic kidney disease (∼50%). Cancer causes not related to lung cancer accounted for 62.2% of deaths in dialysis-dependent end-stage renal disease, which was more frequent than that in the control group (P = .002). Dialysis-dependent end-stage renal disease and nondialysis-dependent chronic kidney disease were independent risk factors for overall survival after lung cancer surgery (hazard ratio, 2.05 [P < .001] and hazard ratio, 2.04 [P = .001], respectively). CONCLUSIONS Preoperative renal dysfunction may be adversely associated with overall survival after lung cancer surgery. Our findings could aid patients to set proper expectation of the risks and benefits about surgery for lung cancer.
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Affiliation(s)
- Tomohito Saito
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan.
| | - Tomohiro Murakawa
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Etsuo Miyaoka
- Department of Mathematics, Tokyo University of Science, Tokyo, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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23
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Diagnosis of Cardiac Surgery-Associated Acute Kidney Injury. J Clin Med 2021; 10:jcm10163664. [PMID: 34441960 PMCID: PMC8397056 DOI: 10.3390/jcm10163664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 01/22/2023] Open
Abstract
Acute kidney injury after cardiac surgery is characterized by specific patterns of damage and recovery that are important to consider for management and outcome. The Kidney Disease: Improving Global Outcomes (KDIGO) classification covers only part of the conceptual framework and is thus insufficient for a comprehensive diagnosis. This review highlights the strengths and limitations of the recent criteria and provides an overview of biomarkers of cardiac surgery-associated acute kidney injury (CSA-AKI). The evolving understanding of CSA-AKI as a time-sensitive condition has increased the demand to enhance the diagnostic criteria and translate biomarkers into clinical practice.
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Wang Y, Li H, Ye H, Xie G, Wu S, Song S, Cheng B, Fang X. Postoperative infectious complications in elderly patients after elective surgery in China: results of a 7-day cohort study from the International Surgical Outcomes Study. Psychogeriatrics 2021; 21:158-165. [PMID: 33415803 DOI: 10.1111/psyg.12648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022]
Abstract
AIM Despite initiatives to increase elderly patients' access to surgical treatments, the prevalence and impact of postoperative infectious complications (PICs) in elderly patients in China are poorly described. The aim of our study was to describe PICs and associated mortality in elderly patients undertaking elective surgery in China. METHODS We analyzed data about elderly patients from China during the International Surgical Outcomes Study (ISOS), a 7-day prospective cohort study of outcomes after elective surgery in in-patient adults. All elderly patients (age ≥60 years) from 28 hospitals in China included in the ISOS study were included in this study as well. A review of 2014 elderly patients who underwent elective surgery in April 2014 was conducted. RESULTS Of 2014 elderly patients, 209 (10.4%) developed at least one postoperative complication. Infectious complications were most frequent, affecting 154 patients (7.6%); there was one death, or 0.6% 30-day mortality, which was a significantly higher rate than among patients without PICs (0%). The most frequent infectious complication was superficial surgical-site infection (3.3%). The length of hospital stay was longer in elderly patients with PICs than in those without PICs. Moreover, a total of 142 elderly patients (7.1%) were routinely sent to critical care after surgery, of whom 97 (68.3%) developed PICs. Compared to elderly patients admitted to a standard ward, those admitted to critical care immediately after surgery had a higher postoperative complication rate and critical care admission rate to treat complications. CONCLUSIONS The present prospective, multicentre study found that 7.6% of elderly patients in China had PICs after elective surgery that could prolong hospital stay and increase 30-day mortality. The clinical effectiveness of admission to critical care after surgery on elderly patients is not identified. Initiatives to increase elderly patients' access to surgical interventions should also enhance safe perioperative care to reduce PICs in China.
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Affiliation(s)
- Yan Wang
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Li
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Ye
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guohao Xie
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuijing Wu
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shengwen Song
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Baoli Cheng
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiangming Fang
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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25
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Agarwal V, Muthuchellappan R, Shah BA, Rane PP, Kulkarni AP. Postoperative Outcomes Following Elective Surgery in India. Indian J Crit Care Med 2021; 25:528-534. [PMID: 34177172 PMCID: PMC8196380 DOI: 10.5005/jp-journals-10071-23807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The incidence of complications and mortality in patients undergoing elective surgery in India are unknown. We contributed Indian data to ISOS. Since there were fewer than ten centers, Indian data were not included in the primary analysis. We report postoperative outcomes in the Indian data set of patients following elective surgery. Materials and methods In this prospective 7-day observational study, after obtaining a waiver of informed consent, data were collected for 30 days from consecutive patients >18 years undergoing elective surgery. The primary outcome was in-hospital postoperative complications. The secondary outcomes were in-hospital all-cause mortality, the relationship between postoperative complications and admission to critical care, and the duration of hospital stay. Complications were graded as mild, moderate, and severe. Failure to rescue was defined as mortality in patients admitted to an intensive care unit (ICU) for the treatment of complications. Results Complications occurred in 57 (27.5%) patients, who were older (53 vs 47 years, p < 0.001) and had American Society of Anaesthesiologists grades III and IV physical status (p = 0.029). One hundred and thirty-eight (65.7%) patients underwent a major surgical procedure of which 132 (62.8%) procedures were done for malignancy. Postoperative complications were significantly higher (41.5% vs 22.7%) in patients electively admitted to ICU. The overall mortality rate was 2.4%, whereas the mortality rate was 8.8% in those who developed complications. Conclusion We found that 28% of patients developed postoperative complications. The overall mortality was 2.4% but was higher (8.8%) in those who developed complications. Age and complex surgical procedures independently predicted complications, while lower preoperative hemoglobin appeared to be protective. Study Registration ISRCTN51817007. How to cite this article Agarwal V, Muthuchellappan R, Shah BA,Rane PP, Kulkarni AP, et al. Postoperative Outcomes Following Elective Surgery in India. Indian J Crit Care Med 2021;25(5):528-534.
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Affiliation(s)
- Vandana Agarwal
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Radhakrishnan Muthuchellappan
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Bhagyesh A Shah
- Department of Intensive Care Medicine, CIMS Hospital, Care Institute of Medical Sciences, Ahmedabad, Gujarat, India
| | - Pallavi P Rane
- Clinical Research Secretariat, Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Navi Mumbai, Maharashtra, India
| | - Atul P Kulkarni
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Pan X, Zhou F, Shen R, Zhu Y, Arima H, Yang J, Zhou J. Influence of renal function on stroke outcome after mechanical thrombectomy: a prospective cohort study. BMC Neurol 2020; 20:134. [PMID: 32290835 PMCID: PMC7155325 DOI: 10.1186/s12883-020-01720-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/07/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND For acute ischemic stroke (AIS) patient receiving mechanical thrombectomy (MT), renal dysfunction was an independent risk factor of contrast-induced nephropathy which may affect clinical outcomes. However, the influence of renal function on stroke outcomes is still controversial. Thus, we aim to investigate the association between renal function and outcomes of AIS patients receiving MT. METHODS All consecutive stroke patients receiving MT were included in a prospective stroke registry in China from April 2015 to February 2019. Estimated glomerular filtration rate (eGFR) was measured on admission and categorized into G1 (≥ 90 ml/min/1.73 m2), G2 (60-89 ml/min/1.73 m2), G3a (45-59 ml/min/1.73 m2) and G3b-5 (≤44 ml/min/1.73 m2). Multivariable logistic regression analysis was performed to evaluate the association between eGFR and recanalization rate (thrombolysis in cerebral infarction scale 2b-3), symptomatic intracranial hemorrhage (sICH), death in hospital, death at 3 months and poor functional outcome (modified Rankin Scale 3-6 at 3 months). RESULTS A total of 373 patients were included in the study. Of them, 130 (34.9%) patients were in the eGFR group G1, 170 (45.6%) in G2, 46 (12.3%) in G3a, 27 (7.2%) in G3b-5. In multivariable logistic regression analysis, reduced eGFR was associated with increased risk of sICH (G3a, p = 0.016) and 3-month death (G3b-5, p = 0.025). However, no significant effects were observed between reduced eGFR and the risk of recanalization rate (p = 0.855), death in hospital (p = 0.970), and poor functional outcome (p = 0.644). CONCLUSIONS For AIS patients underwent MT, reduced eGFR was associated with increased risk of sICH and 3-month death. However, there were no appreciable effects of reduced eGFR on recanalization rate, death in hospital and 3-month functional outcome.
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Affiliation(s)
- Xiding Pan
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Feng Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Rui Shen
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yubing Zhu
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Jie Yang
- Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Billings FT. Acute Kidney Injury following Cardiac Surgery: A Clinical Model. Nephron Clin Pract 2019; 143:202-206. [PMID: 31269500 DOI: 10.1159/000501559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/12/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Scientists use preclinical models of acute kidney injury (AKI) to decipher mechanisms and develop therapy, but translation of therapies to patients remains poor. Models that better resemble patients, including those within clinical care, should be considered. SUMMARY Mice provide many advantages to the study of human disease including an ability to dictate precise experimental conditions. To best isolate and measure phenomena, scientists reduce experimental variability - identical animals, environmental conditions, experimental exposures, and outcome assessments. This technique reduces effect size variability and increases power but dissociates these model organisms from the clinical patients they intend to represent, potentially accounting for the poor translation of findings into patient care. Clinical research, conversely, is often plagued by heterogeneous patients, heterogenous environmental factors, and heterogenous renal insults. A compromise between these 2 extremes - a model of AKI that is more similar to human disease but still provides opportunities for rigorous investigation - should be utilized. Cardiac surgery provides a clinical model for the study of AKI due to mechanism overlap it shares with other clinical conditions (improved generalizability) and characteristics that provide distinct opportunities for research. The high rate of AKI following cardiac surgery and the relative homogeneity (decreased variability) of cardiac surgery subjects, their environment, and renal insults increase power and the opportunity to make discoveries and advance care. Moreover, the elective nature of cardiac surgery provides opportunities to perform detailed baseline assessments and pretreat select patients. Key Messages: Models that better reflect clinical AKI are needed to decipher mechanisms and develop effective treatments. Cardiac surgery is an important clinical model form for the study of AKI.
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Affiliation(s)
- Frederic T Billings
- Division of Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA,
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28
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Acute Kidney Injury, Chronic Kidney Disease, and Mortality: Understanding the Association. Anesth Analg 2019; 128:841-843. [PMID: 30994543 DOI: 10.1213/ane.0000000000004009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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