Ahmed ElSaeed Abdulgalil, Islam H Metwally, Mohammad Zuhdy, Reham Alghandour, Shehab Hasan, Selim Tarabeah, Eman Shahda, Shadi Awny
{"title":"结直肠癌术后急性肾损伤的患病率及危险因素分析。","authors":"Ahmed ElSaeed Abdulgalil, Islam H Metwally, Mohammad Zuhdy, Reham Alghandour, Shehab Hasan, Selim Tarabeah, Eman Shahda, Shadi Awny","doi":"10.1007/s12029-025-01169-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Acute kidney injury is a sentinel event affecting colorectal cancer patients either as a consequence of surgery or systemic chemotherapy. It is highly correlated with both short and long-term adverse outcomes. This work aimed to study the prevalence, risk factors, and impact on survival of postoperative (PO-AKI) and post-chemotherapy (PC-AKI) after colorectal cancer (CRC) surgery in Egyptian patients.</p><p><strong>Methods: </strong>Data of the patients with CRC who underwent surgery over the previous 5 years was retrieved from an internet-based medical system. The incidence of PO-AKI and PC-AKI was calculated, the rate and time to resolution of PO-AKI were recorded, and the possible predictors of AKI were assessed using univariate and multivariate analysis; also, the impact of AKI on patients' survival was tested using survival curves.</p><p><strong>Results: </strong>Five hundred sixty-one cases fulfilled the inclusion criteria and were included in the study. PO-AKI was detected in 10.5% of the patients. Significant risk factors included intraoperative hypotension, sepsis, hypoalbuminemia, amount of intraoperative bleeding, neoadjuvant therapy, and preoperative chronic kidney disease (CKD). However, only neoadjuvant treatment (hazard ratio (HR) 2.2) and CKD (HR 3.3) maintained significant risk in the multivariate analysis. PC-AKI was observed in 18.7% of the patients treated. Significant risk factors were previous CKD and the chemotherapy type, mainly affecting those who received Irinotecan-based therapy. The hazard ratio was 8.5 and 2.4 respectively, in multivariate analysis. The overall survival was significantly worse in those who developed PO- or PC-AKI (p < 0.001).</p><p><strong>Conclusion: </strong>AKI affects more than 25% of CRC patients after surgery and/or chemotherapy. Modifiable risk factors include preoperative hypoalbuminemia, intraoperative bleeding, and/or intraoperative hypotension. While, the more important risk factors were non-modifiable including CKD, neoadjuvant therapy, and Irinotecan-containing regimens. Most kidney injuries are stage I; however, they are associated with shorter overall survival.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"56 1","pages":"45"},"PeriodicalIF":1.6000,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prevalence and Risk Factors of Acute Kidney Injury After Colorectal Cancer Surgery.\",\"authors\":\"Ahmed ElSaeed Abdulgalil, Islam H Metwally, Mohammad Zuhdy, Reham Alghandour, Shehab Hasan, Selim Tarabeah, Eman Shahda, Shadi Awny\",\"doi\":\"10.1007/s12029-025-01169-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Acute kidney injury is a sentinel event affecting colorectal cancer patients either as a consequence of surgery or systemic chemotherapy. It is highly correlated with both short and long-term adverse outcomes. This work aimed to study the prevalence, risk factors, and impact on survival of postoperative (PO-AKI) and post-chemotherapy (PC-AKI) after colorectal cancer (CRC) surgery in Egyptian patients.</p><p><strong>Methods: </strong>Data of the patients with CRC who underwent surgery over the previous 5 years was retrieved from an internet-based medical system. The incidence of PO-AKI and PC-AKI was calculated, the rate and time to resolution of PO-AKI were recorded, and the possible predictors of AKI were assessed using univariate and multivariate analysis; also, the impact of AKI on patients' survival was tested using survival curves.</p><p><strong>Results: </strong>Five hundred sixty-one cases fulfilled the inclusion criteria and were included in the study. PO-AKI was detected in 10.5% of the patients. Significant risk factors included intraoperative hypotension, sepsis, hypoalbuminemia, amount of intraoperative bleeding, neoadjuvant therapy, and preoperative chronic kidney disease (CKD). However, only neoadjuvant treatment (hazard ratio (HR) 2.2) and CKD (HR 3.3) maintained significant risk in the multivariate analysis. PC-AKI was observed in 18.7% of the patients treated. Significant risk factors were previous CKD and the chemotherapy type, mainly affecting those who received Irinotecan-based therapy. The hazard ratio was 8.5 and 2.4 respectively, in multivariate analysis. The overall survival was significantly worse in those who developed PO- or PC-AKI (p < 0.001).</p><p><strong>Conclusion: </strong>AKI affects more than 25% of CRC patients after surgery and/or chemotherapy. Modifiable risk factors include preoperative hypoalbuminemia, intraoperative bleeding, and/or intraoperative hypotension. While, the more important risk factors were non-modifiable including CKD, neoadjuvant therapy, and Irinotecan-containing regimens. Most kidney injuries are stage I; however, they are associated with shorter overall survival.</p>\",\"PeriodicalId\":15895,\"journal\":{\"name\":\"Journal of Gastrointestinal Cancer\",\"volume\":\"56 1\",\"pages\":\"45\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-01-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Gastrointestinal Cancer\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s12029-025-01169-0\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Gastrointestinal Cancer","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12029-025-01169-0","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ONCOLOGY","Score":null,"Total":0}
Prevalence and Risk Factors of Acute Kidney Injury After Colorectal Cancer Surgery.
Purpose: Acute kidney injury is a sentinel event affecting colorectal cancer patients either as a consequence of surgery or systemic chemotherapy. It is highly correlated with both short and long-term adverse outcomes. This work aimed to study the prevalence, risk factors, and impact on survival of postoperative (PO-AKI) and post-chemotherapy (PC-AKI) after colorectal cancer (CRC) surgery in Egyptian patients.
Methods: Data of the patients with CRC who underwent surgery over the previous 5 years was retrieved from an internet-based medical system. The incidence of PO-AKI and PC-AKI was calculated, the rate and time to resolution of PO-AKI were recorded, and the possible predictors of AKI were assessed using univariate and multivariate analysis; also, the impact of AKI on patients' survival was tested using survival curves.
Results: Five hundred sixty-one cases fulfilled the inclusion criteria and were included in the study. PO-AKI was detected in 10.5% of the patients. Significant risk factors included intraoperative hypotension, sepsis, hypoalbuminemia, amount of intraoperative bleeding, neoadjuvant therapy, and preoperative chronic kidney disease (CKD). However, only neoadjuvant treatment (hazard ratio (HR) 2.2) and CKD (HR 3.3) maintained significant risk in the multivariate analysis. PC-AKI was observed in 18.7% of the patients treated. Significant risk factors were previous CKD and the chemotherapy type, mainly affecting those who received Irinotecan-based therapy. The hazard ratio was 8.5 and 2.4 respectively, in multivariate analysis. The overall survival was significantly worse in those who developed PO- or PC-AKI (p < 0.001).
Conclusion: AKI affects more than 25% of CRC patients after surgery and/or chemotherapy. Modifiable risk factors include preoperative hypoalbuminemia, intraoperative bleeding, and/or intraoperative hypotension. While, the more important risk factors were non-modifiable including CKD, neoadjuvant therapy, and Irinotecan-containing regimens. Most kidney injuries are stage I; however, they are associated with shorter overall survival.
期刊介绍：
The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.
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