{"title":"围手术期氨基酸给药的手术特异性模式和相关的急性肾损伤风险：一项大规模回顾性队列研究。","authors":"Jin Lina, Zhang Rui, Yu Xianjun, Wu Xiuqing, Zhang Yingli, Huang Yukun, Zhang Yiwei, Huang Changshun, Zhu Binbin","doi":"10.1186/s13741-025-00573-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Recent trials demonstrated renoprotective effects of amino acid infusion in cardiac surgery patients, but real-world utilization patterns and outcomes across surgical specialties remain unknown. We investigated perioperative amino acid administration patterns and associated acute kidney injury (AKI) risk across different surgical populations.</p><p><strong>Methods: </strong>Retrospective cohort study using the INSPIRE database (2011-2020) from Seoul National University Hospital. Adult patients undergoing surgery with ≥ 24-h stays were included. Amino acid preparations were identified by ATC codes, and AKI was defined by KDIGO criteria. Primary outcomes were AKI incidence and utilization patterns across surgical departments.</p><p><strong>Results: </strong>Among 22,972 patients, 899 (3.9%) received peri-operative amino acid preparations with an overall AKI incidence of 3.7%. Utilization varied 60-fold across departments (0.2-11.5%). Surgery-specific patterns emerged: cardiac surgery showed no AKI events in amino acid users (0/50) versus 4.2% in non-users (p = 0.267), while non-cardiac surgery demonstrated increased AKI risk with amino acid use (7.4% vs 3.4%; RR = 2.16, 95% CI 1.65-2.85, p < 0.001). Multivariable analysis confirmed amino acid use as an independent AKI predictor (OR = 2.01, 95% CI 1.52-2.60). Machine learning analysis confirmed amino acids as the strongest AKI predictor, with Random Forest achieving superior performance (AUC-ROC 0.782) and revealing significant non-linear interactions. Propensity score matching (799 pairs) confirmed the association (OR = 1.63, 95% CI 1.05-2.52, p = 0.029).</p><p><strong>Conclusions: </strong>Perioperative amino acid administration demonstrates surgery-specific patterns with differential AKI associations. These findings suggest that surgery-specific factors should be considered when developing amino-acid protocols, although causality cannot be established from this observational study.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"86"},"PeriodicalIF":2.1000,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12341336/pdf/","citationCount":"0","resultStr":"{\"title\":\"Surgery-specific patterns of perioperative amino acid administration and associated acute kidney injury risk: a large-scale retrospective cohort study.\",\"authors\":\"Jin Lina, Zhang Rui, Yu Xianjun, Wu Xiuqing, Zhang Yingli, Huang Yukun, Zhang Yiwei, Huang Changshun, Zhu Binbin\",\"doi\":\"10.1186/s13741-025-00573-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Recent trials demonstrated renoprotective effects of amino acid infusion in cardiac surgery patients, but real-world utilization patterns and outcomes across surgical specialties remain unknown. We investigated perioperative amino acid administration patterns and associated acute kidney injury (AKI) risk across different surgical populations.</p><p><strong>Methods: </strong>Retrospective cohort study using the INSPIRE database (2011-2020) from Seoul National University Hospital. Adult patients undergoing surgery with ≥ 24-h stays were included. Amino acid preparations were identified by ATC codes, and AKI was defined by KDIGO criteria. Primary outcomes were AKI incidence and utilization patterns across surgical departments.</p><p><strong>Results: </strong>Among 22,972 patients, 899 (3.9%) received peri-operative amino acid preparations with an overall AKI incidence of 3.7%. Utilization varied 60-fold across departments (0.2-11.5%). Surgery-specific patterns emerged: cardiac surgery showed no AKI events in amino acid users (0/50) versus 4.2% in non-users (p = 0.267), while non-cardiac surgery demonstrated increased AKI risk with amino acid use (7.4% vs 3.4%; RR = 2.16, 95% CI 1.65-2.85, p < 0.001). Multivariable analysis confirmed amino acid use as an independent AKI predictor (OR = 2.01, 95% CI 1.52-2.60). Machine learning analysis confirmed amino acids as the strongest AKI predictor, with Random Forest achieving superior performance (AUC-ROC 0.782) and revealing significant non-linear interactions. Propensity score matching (799 pairs) confirmed the association (OR = 1.63, 95% CI 1.05-2.52, p = 0.029).</p><p><strong>Conclusions: </strong>Perioperative amino acid administration demonstrates surgery-specific patterns with differential AKI associations. These findings suggest that surgery-specific factors should be considered when developing amino-acid protocols, although causality cannot be established from this observational study.</p>\",\"PeriodicalId\":19764,\"journal\":{\"name\":\"Perioperative Medicine\",\"volume\":\"14 1\",\"pages\":\"86\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-08-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12341336/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Perioperative Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13741-025-00573-1\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Perioperative Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13741-025-00573-1","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：最近的试验表明，氨基酸输注对心脏手术患者的肾保护作用，但实际应用模式和外科专业的结果仍不清楚。我们调查了不同手术人群围手术期氨基酸给药模式和相关的急性肾损伤（AKI）风险。方法：采用首尔国立大学医院INSPIRE数据库（2011-2020）进行回顾性队列研究。纳入住院时间≥24小时的手术成年患者。氨基酸制剂按ATC编码鉴定，AKI按KDIGO标准定义。主要结局是各外科部门AKI的发病率和使用模式。结果：在22972例患者中，899例（3.9%）患者接受了围术期氨基酸制剂治疗，AKI总发生率为3.7%。各部门的使用率相差60倍（0.2-11.5%）。出现了手术特异性模式：心脏手术显示氨基酸使用者无AKI事件（0/50），而非氨基酸使用者为4.2% (p = 0.267)，而非心脏手术显示氨基酸使用增加了AKI风险(7.4% vs 3.4%；RR = 2.16, 95% CI 1.65-2.85， p结论：围手术期氨基酸给药显示手术特异性模式与AKI差异相关。这些发现表明，在制定氨基酸方案时应考虑手术特异性因素，尽管该观察性研究无法确定因果关系。
Surgery-specific patterns of perioperative amino acid administration and associated acute kidney injury risk: a large-scale retrospective cohort study.
Background: Recent trials demonstrated renoprotective effects of amino acid infusion in cardiac surgery patients, but real-world utilization patterns and outcomes across surgical specialties remain unknown. We investigated perioperative amino acid administration patterns and associated acute kidney injury (AKI) risk across different surgical populations.
Methods: Retrospective cohort study using the INSPIRE database (2011-2020) from Seoul National University Hospital. Adult patients undergoing surgery with ≥ 24-h stays were included. Amino acid preparations were identified by ATC codes, and AKI was defined by KDIGO criteria. Primary outcomes were AKI incidence and utilization patterns across surgical departments.
Results: Among 22,972 patients, 899 (3.9%) received peri-operative amino acid preparations with an overall AKI incidence of 3.7%. Utilization varied 60-fold across departments (0.2-11.5%). Surgery-specific patterns emerged: cardiac surgery showed no AKI events in amino acid users (0/50) versus 4.2% in non-users (p = 0.267), while non-cardiac surgery demonstrated increased AKI risk with amino acid use (7.4% vs 3.4%; RR = 2.16, 95% CI 1.65-2.85, p < 0.001). Multivariable analysis confirmed amino acid use as an independent AKI predictor (OR = 2.01, 95% CI 1.52-2.60). Machine learning analysis confirmed amino acids as the strongest AKI predictor, with Random Forest achieving superior performance (AUC-ROC 0.782) and revealing significant non-linear interactions. Propensity score matching (799 pairs) confirmed the association (OR = 1.63, 95% CI 1.05-2.52, p = 0.029).
Conclusions: Perioperative amino acid administration demonstrates surgery-specific patterns with differential AKI associations. These findings suggest that surgery-specific factors should be considered when developing amino-acid protocols, although causality cannot be established from this observational study.
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