Abstract
BackgroundPostoperative acute kidney injury (AKI) is associated with higher morbidity, mortality, and economic burden. However, there is a lack of evaluation of postoperative AKI in highly heterogeneous critically ill patients undergoing emergency surgery. To explore the incidence, risk factors, and prognosis, to clarify the epidemiological status, and to improve the early identification and diagnosis of postoperative AKI, this study was taken.MethodsA prospective observational study was conducted in the general intensive care units of Guangdong Provincial People's Hospital from January 2014 to March 2018. Preoperative variables, intraoperative variables, postoperative variables, and postoperative prognosis data were collected. The diagnosis and staging of postoperative AKI were based on the Kidney Disease: Improving Global Outcomes criteria. They were divided into two groups according to whether postoperative AKI occurred: AKI group and non-AKI group. The baseline characteristics, postoperative AKI incidence, AKI stage, and in-hospital prognosis in all enrolled patients were analyzed prospectively. Multivariate logistic forward stepwise (odds ratio, OR) regression was used to determine the independent risk factors of postoperative AKI. Results were presented using the OR with 95% confidence intervals (CIs).ResultsA total of 383 critically ill patients undergoing emergency surgery, 151 (39.4%) patients among them developed postoperative AKI. Postoperative reoperation, postoperative Acute Physiology and Chronic Health Evaluation (APACHE II) score, postoperative serum lactic acid (LAC), postoperative serum creatinine (sCr) were independent risk factors for postoperative AKI in critically ill patients undergoing emergency surgery, with the adjusted OR (ORadj) of 1.854 ( 95% CI, 1.091 - 3.152), 1.059 ( 95% CI, 1.018 - 1.102), 1. 239 (95% CI, 1.047 - 1.467), and 3.934 (95% CI, 2.426 - 6.382), respectively. Duration of mechanical ventilation, renal replacement therapy, ICU and hospital mortality, ICU and hospital length of stay, total ICU and hospital costs were higher in the AKI group than in the non-AKI group.ConclusionsThe independent risk factors which included postoperative reoperation, postoperative APACHE II score, postoperative LAC, and postoperative sCr could improve the early diagnosis and prevention of postoperative AKI and identify the higher risk of adverse outcomes in critically ill patients undergoing emergency surgery.