Epidemiology and Long-term Outcomes of Acute Kidney Injury in Adult Patients with Perforation Peritonitis Undergoing Emergency Laparotomy.

IF 1.5 Q3 CRITICAL CARE MEDICINE

Indian Journal of Critical Care Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-31 DOI:10.5005/jp-journals-10071-24796

Pallavi Priya, Dalim K Baidya, Rahul K Anand, Bikash R Ray, Puneet Khanna, Asuri Krishna, Souvik Maitra

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Abstract

Background: Reported incidence of acute kidney injury (AKI) is around 5.0-7.5% of all hospitalized patients, and 40% of them are postoperative patients. Major abdominal surgeries account for 3.1-35% of cases of postoperative AKI in various series. The aim of the study was to identify the incidence and risk factors of AKI in peritonitis patients undergoing emergency laparotomy.

Materials and methods: Adult patients aged 18-65 years undergoing emergency laparotomy for perforation peritonitis were included in this prospective observational study. Baseline clinical and laboratory data, intraoperative details and postoperative outcome data (AKI at day 7, length of intensive care unit and hospital stay, and mortality) were recorded. Logistic regression model was constructed to predict AKI at day 7.

Results: N = 140 patients were included in this study and 69 patients (49.3%) developed AKI within day 7. Larger volume of crystalloid [OR (95% CI) 1.00 (1.00-1.00); p = 0.012], intraoperative vasopressor use (OR 7.42 (2.41-22.83); p < 0.001), intraoperative blood loss [OR 1.004(1.00-1.01); p = 0.003] and the presence of chronic liver disease (CLD) [OR 22.44 (1.68-299.26); p = 0.019] were risk factors for the development of AKI. Acute kidney injury patients had increased mortality at day 90 (24.6% vs 1.4%; p < 0.001), length of ICU stay (3 days vs 0 days, p < 0.001), and length of hospital stay (11 days vs 7 days; p < 0.001).

Conclusion: In peritonitis patients undergoing emergency laparotomy, as many as 49% of patients develop AKI within 1 week. The presence of CLD, intraoperative blood loss, and the use of crystalloids and vasopressor increase the odds of developing AKI.

How to cite this article: Priya P, Baidya DK, Anand RK, Ray BR, Khanna P, Krishna A, et al. Epidemiology and Long-term Outcomes of Acute Kidney Injury in Adult Patients with Perforation Peritonitis Undergoing Emergency Laparotomy. Indian J Crit Care Med 2024;28(9):854-858.

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接受急诊腹腔镜手术的穿孔性腹膜炎成人患者急性肾损伤的流行病学和长期疗效。

背景：据报道，在所有住院病人中，急性肾损伤（AKI）的发病率约为 5.0-7.5%，其中 40% 为术后病人。在各种系列的术后 AKI 病例中，腹部大手术占 3.1-35%。该研究旨在确定接受急诊开腹手术的腹膜炎患者 AKI 的发生率和风险因素：这项前瞻性观察研究纳入了因腹膜炎穿孔而接受急诊开腹手术的 18-65 岁成人患者。研究记录了基线临床和实验室数据、术中细节和术后结果数据（第7天的AKI、重症监护室和住院时间以及死亡率）。建立了逻辑回归模型来预测第7天的AKI：本研究共纳入 140 名患者，其中 69 名患者（49.3%）在术后第 7 天出现了 AKI。较大的晶体液用量[OR (95% CI) 1.00 (1.00-1.00); p = 0.012]、术中使用血管加压药（OR 7.42 (2.41-22.83); p < 0.001）、术中失血[OR 1.004(1.00-1.01); p = 0.003]和存在慢性肝病（CLD）[OR 22.44 (1.68-299.26); p = 0.019]是发生急性肾损伤的危险因素。急性肾损伤患者第90天的死亡率（24.6% vs 1.4%；P < 0.001）、重症监护室住院时间（3天 vs 0天，P < 0.001）和住院时间（11天 vs 7天；P < 0.001）均有所增加：结论：在接受急诊开腹手术的腹膜炎患者中，多达49%的患者会在1周内发生AKI。结论：在接受急诊开腹手术的腹膜炎患者中，多达49%的患者会在1周内发生AKI，CLD的存在、术中失血以及晶体液和血管加压剂的使用都会增加发生AKI的几率：Priya P、Baidya DK、Anand RK、Ray BR、Khanna P、Krishna A 等：《急诊腹腔镜手术穿孔性腹膜炎成人患者急性肾损伤的流行病学和长期预后》。Indian J Crit Care Med 2024;28(9):854-858.

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来源期刊

Indian Journal of Critical Care Medicine CRITICAL CARE MEDICINE-

CiteScore

3.50

自引率

10.00%

发文量

299

期刊介绍： Indian Journal of Critical Care Medicine (ISSN 0972-5229) is specialty periodical published under the auspices of Indian Society of Critical Care Medicine. Journal encourages research, education and dissemination of knowledge in the fields of critical and emergency medicine.