Intraoperative renal desaturation and postoperative acute kidney injury in older patients undergoing liver resection: A prospective cohort study - 26/04/23
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.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Renal tissue oxygen saturation declines frequently during hepatectomy. |
• | Renal tissue desaturation increases the risk of postoperative acute kidney injury. |
• | Renal tissue oxygenation monitoring enhances the detection of acute kidney injury. |
• | Renal tissue desaturation predicts postoperative acute kidney injury. |
Keywords : Renal oxygen saturation, Renal desaturation, Postoperative acute kidney injury, Hepatectomy
Plan
Vol 87
Article 111084- août 2023 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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