Preoperative evaluation of acute renal injury after hepatectomy / 中华肾脏病杂志

ABSTRACT

Objective To explore the risk factors of post-hepatectomy acute kidney injury (AKI),a Nomogram predictive model of secondary AKI after hepatectomy was established which can provide guidance for the selection of clinically relevant treatment plans and improve the prognosis of surgical patients.Methods A total of 2769 patients who underwent hepatectomy in the Affiliated Hospital of Qingdao University from October 2012 to July 2018 were included in the study.The post-hepatectomy AKI was diagnosed according to the KDIGO AKI criteria in 2012.The selected patients were divided into AKI group (n=133) and non-AKI group (n=2636);they were divided into training group (n=2050) and test group (n=719) according to Enrollment time.The differences of preoperative clinical data,length of hospital stay,and in-hospital mortality between patients with AKI and non-AKI group were compared.The risk factors of post-hepatectomy AKI were evaluated by the Cox regression.A Nomogram predictive model of AKI after hepatectomy was established,and receiver operating curve (ROC) and consistency curve were used to verify the accuracy of the predictive model.Results The incidence of AKI after hepatectomy was 4.80％(133/2769).Compared with non-AKI group,preoperative serum albumin,hemoglobin,and hematocrit levels were lower in AKI group;the level of blood transaminase,total bilirubin,alkaline phosphatase,triglyceride,lactate dehydrogenase,and fibrinogen were higher (P ＜ 0.050);the proportion of preoperative aspirin application was higher (P ＜ 0.001);the duration of operation was longer (P=0.002);the proportion of open surgery was higher (P ＜ 0.001);the mortality rate was higher (P ＜ 0.050);the length of hospital stay was longer (P ＜ 0.050).Cox regression results showed hypertriglyceridemia,hypoalbuminemia,alkaline phosphatase,aspartate aminotransferase,open surgery,lower preoperative glomerular filtration rate,aspirin and duration of surgery were independent risk factors for AKI.We incorporated these indicators into the Nomogram to establish a predictive model for AKI after hepatectomy,the area under ROC curve was 0.764.The area under ROC curve of the test group was 0.781.Conclusion The Nomogram predicting model of AKI after hepatectomy has high accuracy,which is helpful for prognosis of patients who underwent hepatectomy.