Jin Li, Yeshuo Ma, Yang Li, Wen Ouyang, Zongdao Liu, Xing Liu, Bo Li, Jie Xiao, Daqing Ma, Yongzhong Tang
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Patients' baseline demographics, pre- and post-operative data were harvested and then analyzed with multivariable logistic regression to assess the exposure-outcome relationship.</p><p><strong>Results: </strong>Among 6552 hypertension patients, 579 (8.84%) had postoperative AKI after non-cardiac surgery. The proportions of patients admitted to ICU (3.97 vs. 1.24%, <i>p</i> < 0.001) and experiencing all-cause death (2.76 vs. 0.80%, <i>p</i> < 0.001) were higher in the patients with postoperative AKI. Moreover, the patients with postoperative AKI had longer hospital stays (13.50 vs. 12.00 days, <i>p</i> < 0.001). Intraoperative mean arterial pressure (MAP) < 60 mmHg for >20 min was an independent risk factor of postoperative AKI. Furthermore, MAP <60 mmHg for >10 min was also an independent risk factor of postoperative AKI in patients whose MAP was measured invasively in the subgroup analysis.</p><p><strong>Conclusions: </strong>Our work suggested that MAP < 60 mmHg for >10 min measured invasively or 20 min measured non-invasively during non-cardiac surgery may be the threshold of postoperative AKI development in hypertension patients. 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引用次数: 0
摘要
背景：急性肾损伤（AKI）是一种常见的外科并发症，与术中低血压有关。然而，与 AKI 相关的术中低血压的总持续时间和程度仍不清楚。本研究调查了接受非心脏手术的慢性高血压患者术中动脉压与术后 AKI 之间的因果关系：该研究对 6552 名接受非心脏手术的高血压患者（2011 年至 2019 年）进行了回顾性队列研究。主要结果是根据肾脏疾病-改善全球结果标准诊断出的 AKI，主要暴露是术中低血压。研究人员收集了患者的基线人口统计学数据、术前和术后数据，然后通过多变量逻辑回归进行分析，以评估暴露与结果之间的关系：在 6552 名高血压患者中，有 579 人（8.84%）在非心脏手术后出现术后 AKI。入住重症监护室的患者比例（3.97% vs. 1.24%，p p p 20 分钟）是术后 AKI 的独立风险因素。此外，在亚组分析中，在有创测量 MAP 的患者中，MAP 10 分钟也是术后 AKI 的独立风险因素：我们的研究表明，在非心脏手术过程中，有创测量 10 分钟或无创测量 20 分钟的 MAP < 60 mmHg 可能是高血压患者术后发生 AKI 的阈值。这项工作可作为慢性高血压患者围手术期管理指南：ChiCTR2100050209 (8/22/2021). http://www.chictr.org.cn/showproj.aspx?proj=132277.
Intraoperative hypotension associated with postoperative acute kidney injury in hypertension patients undergoing non-cardiac surgery: a retrospective cohort study.
Background: Acute kidney injury (AKI) is a common surgical complication and is associated with intraoperative hypotension. However, the total duration and magnitude of intraoperative hypotension associated with AKI remains unknown. In this study, the causal relationship between the intraoperative arterial pressure and postoperative AKI was investigated among chronic hypertension patients undergoing non-cardiac surgery.
Methods: A retrospective cohort study of 6552 hypertension patients undergoing non-cardiac surgery (2011 to 2019) was conducted. The primary outcome was AKI as diagnosed with the Kidney Disease-Improving Global Outcomes criteria and the primary exposure was intraoperative hypotension. Patients' baseline demographics, pre- and post-operative data were harvested and then analyzed with multivariable logistic regression to assess the exposure-outcome relationship.
Results: Among 6552 hypertension patients, 579 (8.84%) had postoperative AKI after non-cardiac surgery. The proportions of patients admitted to ICU (3.97 vs. 1.24%, p < 0.001) and experiencing all-cause death (2.76 vs. 0.80%, p < 0.001) were higher in the patients with postoperative AKI. Moreover, the patients with postoperative AKI had longer hospital stays (13.50 vs. 12.00 days, p < 0.001). Intraoperative mean arterial pressure (MAP) < 60 mmHg for >20 min was an independent risk factor of postoperative AKI. Furthermore, MAP <60 mmHg for >10 min was also an independent risk factor of postoperative AKI in patients whose MAP was measured invasively in the subgroup analysis.
Conclusions: Our work suggested that MAP < 60 mmHg for >10 min measured invasively or 20 min measured non-invasively during non-cardiac surgery may be the threshold of postoperative AKI development in hypertension patients. This work may serve as a perioperative management guide for chronic hypertension patients.
期刊介绍：
The first open access journal in the field of burns and trauma injury in the Asia-Pacific region, Burns & Trauma publishes the latest developments in basic, clinical and translational research in the field. With a special focus on prevention, clinical treatment and basic research, the journal welcomes submissions in various aspects of biomaterials, tissue engineering, stem cells, critical care, immunobiology, skin transplantation, and the prevention and regeneration of burns and trauma injuries. With an expert Editorial Board and a team of dedicated scientific editors, the journal enjoys a large readership and is supported by Southwest Hospital, which covers authors'' article processing charges.
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