BJS open · 2025
Acute kidney injury after major hepatectomy: association with postoperative complications and post-hepatectomy liver failure.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Swartling Oskar, Reese Tim, Hasselgren Kristina, Engstrand Jennie, Kern Anna Emilia, Baumgartner Ruth, Ghorbani Poya, Sandström Per, Sparrelid Ernesto, Oldhafer Karl J, Björnsson Bergthor, Gilg Stefan
Аннотация
BACKGROUND: Patients undergoing liver resections are at increased risk of acute kidney injury (AKI). The objective of this study was to examine AKI after major hepatectomy and the associated risk of adverse postoperative outcomes, including post-hepatectomy liver failure (PHLF) and mortality.
METHODS: All adult patients undergoing major hepatectomy between 2010 and 2021 at three tertiary referral centres in Sweden and Germany were included. Postoperative AKI was based on standardized criteria using serum creatinine and urine output. Logistic regression models were used to explore associations with adverse events.
RESULTS: In all, 1561 patients were included in the study, of whom 400 (25.6%) developed AKI of any grade. Risk factors for AKI included male sex, higher age, and a low preoperative estimated glomerular filtration rate. Patients with AKI were at increased risk of intensive care unit admission (adjusted odds ratio (aOR) 6.06; 95% confidence interval (c.i.) 2.83 to 12.95), Clavien-Dindo grade ≥ IIIa (aOR 2.08; 95% c.i. 1.61 to 2.67) and PHLF grade B or C (aOR 2.87; 95% c.i. 2.11 to 3.90). Patients with only AKI and patients with both AKI and PHLF grade B or C had an increased risk of 90-day mortality than patients with neither. Postoperative AKI was associated with an increased risk of 90-day mortality even after adjustment for PHLF.
CONCLUSION: AKI after major hepatectomy is a common complication and is associated with considerable morbidity and mortality. Postoperative AKI may be both an early risk factor for PHLF after major hepatectomy and independently contribute to 90-day mortality.
METHODS: All adult patients undergoing major hepatectomy between 2010 and 2021 at three tertiary referral centres in Sweden and Germany were included. Postoperative AKI was based on standardized criteria using serum creatinine and urine output. Logistic regression models were used to explore associations with adverse events.
RESULTS: In all, 1561 patients were included in the study, of whom 400 (25.6%) developed AKI of any grade. Risk factors for AKI included male sex, higher age, and a low preoperative estimated glomerular filtration rate. Patients with AKI were at increased risk of intensive care unit admission (adjusted odds ratio (aOR) 6.06; 95% confidence interval (c.i.) 2.83 to 12.95), Clavien-Dindo grade ≥ IIIa (aOR 2.08; 95% c.i. 1.61 to 2.67) and PHLF grade B or C (aOR 2.87; 95% c.i. 2.11 to 3.90). Patients with only AKI and patients with both AKI and PHLF grade B or C had an increased risk of 90-day mortality than patients with neither. Postoperative AKI was associated with an increased risk of 90-day mortality even after adjustment for PHLF.
CONCLUSION: AKI after major hepatectomy is a common complication and is associated with considerable morbidity and mortality. Postoperative AKI may be both an early risk factor for PHLF after major hepatectomy and independently contribute to 90-day mortality.