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Acute kidney injury after hepatectomy can be reasonably predicted after surgery
Author(s) -
Kim Minjae,
Kiran Ravi P.,
Li Guohua
Publication year - 2019
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.615
Subject(s) - medicine , odds ratio , acute kidney injury , hepatectomy , confidence interval , hematocrit , logistic regression , creatinine , body mass index , surgery , cohort , receiver operating characteristic , urology , resection
Background Hepatectomy presents unique challenges potentially heightening acute kidney injury ( AKI ) risk, but the full spectrum of risk factors has not been identified. Methods Data for hepatectomy patients in the 2016 American College of Surgeons National Surgical Quality Improvement Program ( n = 3,814) was randomly split into derivation (70%) and validation (30%) cohorts. AKI was defined as an increase in serum creatinine ≥0.3 mg/dl or ≥1.5‐fold above the preoperative value within 30 days of surgery. Multivariable logistic regression assessed preoperative and intraoperative risk factors for AKI . Results Of 2,692 patients (derivation cohort), 432 (16%) developed AKI . Risk factors were the following: age (years; adjusted odds ratio [ aOR ] 1.016 [95% confidence interval 1.006–1.026], female sex ( aOR 0.65 [0.51–0.82]), body mass index (kg/m 2 ; aOR 1.043 [1.024–1.062]), diabetes ( aOR 1.71 [1.31–2.24]), hypertension ( aOR 1.66 [1.30–2.13]), hematocrit (%; aOR 0.944 [0.924–0.966]), operative time (min; aOR 1.004 [1.003–1.004]), planned open procedure ( aOR 2.00 [1.47–2.73]), and Pringle maneuver ( aOR 1.36 [1.07–1.72]). The areas under the curve of the receiver operating characteristic curves were 0.74 (95% CI 0.71–0.76) and 0.71 (95% CI 0.67–0.75) in the derivation and validation cohorts, respectively. Conclusions Postoperative AKI affects one in six hepatectomy patients; preoperative and intraoperative factors can predict the risk of postoperative AKI .