Intraoperative renal desaturation and postoperative acute kidney injury in older patients undergoing liver resection: A prospective cohort study - 26/04/23

Doi : 10.1016/j.jclinane.2023.111084

Yao Yu, MD ^a,^{^{1
Yao Yu and Haotian Wu contributed equally to this work.}}, Haotian Wu, MD ^b,^{^{1
Yao Yu and Haotian Wu contributed equally to this work.}}, Chang Liu, MD ^a, Changsheng Zhang, MD, PhD ^a, Yuxiang Song, MD ^a, Yulong Ma, MD, PhD ^a, Hao Li, MD, PhD ^a, Jingsheng Lou, MD, PhD ^a, Yanhong Liu, MD, PhD ^a, Jiangbei Cao, MD, PhD ^a, Huan Zhang, MD, PhD ^b, Zhipeng Xu, MD, PhD ^c, Roger G. Evans, PhD ^d,^e, Chongyang Duan, PhD ^f,^{^⁎} , Weidong Mi, MD, PhD ^a,^{^⁎}
^a Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
^b Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
^c Department of Anesthesiology, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
^d Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
^e Florey Institute of Neurosciences and Mental Health, University of Melbourne, Melbourne, Australia
^f Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China

^⁎Corresponding authors at: The First Medical Center of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing 100853, China; Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China.The First Medical Center of Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing 100853, ChinaDepartment of BiostatisticsSchool of Public HealthSouthern Medical UniversityGuangzhouChina

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.

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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.

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Keywords : Renal oxygen saturation, Renal desaturation, Postoperative acute kidney injury, Hepatectomy

Plan

Introduction

Materials and methods

Study design and population

Anesthetic and surgical procedures

Near-infrared spectroscopy

Outcomes

Confounding variables

Statistical analysis

Results

Patient characteristics

Incidence of postoperative AKI and secondary outcomes

Association between renal desaturation and AKI

Additive value of renal desaturation in identifying AKI

Discussion

Conclusion

Funding

CRediT authorship contribution statement

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Vol 87

Article 111084- août 2023 Retour au numéro

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Intraoperative renal desaturation and postoperative acute kidney injury in older patients undergoing liver resection: A prospective cohort study - 26/04/23

Abstract

Study objective

Design

Setting

Patients

Interventions and measurements

Main results

Conclusions

Highlights

Plan

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