非心脏手术后轻度急性肾损伤与长期肾功能障碍相关：一项回顾性队列研究
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Mild Acute Kidney Injury after Noncardiac Surgery Is Associated with Long-term Renal Dysfunction: A Retrospective Cohort Study
背景与目的
围手术期急性肾损伤是常见的。然而，目前尚不清楚这是否仅仅代表肌酐的短暂增加或具有预后价值。因此，术后轻度急性肾损伤的长期临床意义尚不清楚。这项研究旨在评估非心脏手术后有/无轻度肾损伤的成年患者是否具有相似的长期肾损伤风险。
方 法
此项研究为一项回顾性队列分析，对在克利夫兰诊所接受非心脏手术的成年患者进行术前、术后和长期（术后1-2年）血浆肌酐水平测定。根据改善全球肾脏病预后组织（KDIGO）标准对肾脏疾病的暴露（术后急性肾损伤）和转归（长期肾损伤）进行定义和分级。主要观察指标为术后肾损伤(I期与无损伤)和长期肾损伤之间的相关性。
结 果
本研究共纳入15621例患者，其中有3%的患者发生术后I期肾损伤。在有和无术后I期损伤的患者中，长期肾脏结局存在明显差异。具体地说，约26%的术后I期肾损伤患者在1-2年后仍有轻度损伤，11%的患者有更严重的肾损伤。因此，近三分之一(37%)的I期肾损伤患者在手术后1-2年出现肾损伤。在调整潜在混杂因素后，术后I期损伤患者发生长期肾功能不全(KDIGO I期、II期或III期)的概率是无术后肾损伤患者的2.4倍(比值比[95% CI] 为2.4[2.0 - 3.0])。
结 论
在实施非心脏手术后处于恢复期的成年患者中，即使术后血肌酐轻微升高（与I期肾损伤相对应），也与术后1-2年的肾功能障碍有关。因此，即使是轻微的术后肾损伤也应该被视为是临床重要的围手术期结局。
原始文献摘要
Turan A, Cohen B, Adegboye J, et al. Mild Acute Kidney Injury after Noncardiac Surgery Is Associated with Long-term Renal Dysfunction: A Retrospective Cohort Study.[J] .Anesthesiology, 2020, undefined: undefined.
Background: Perioperative acute kidney injury is common. However, it is unclear whether this merely represents a transient increase in creatinine or has prognostic value. Therefore, the long-term clinical importance of mild postoperative acute kidney injury remains unclear. This study assessed whether adults who do and do not experience mild kidney injury after noncardiac surgery are at similar risk for long-term renal injury.
Methods: This study is a retrospective cohort analysis of adults having noncardiac surgery at the Cleveland Clinic who had preoperative, postoperative, and long-term (1 to 2 yr after surgery) plasma creatinine measurements. The exposure (postoperative kidney injury) and outcome (long-term renal injury) were defined and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) initiative criteria. The primary analysis was for lack of association between postoperative kidney injury (stage I vs. no injury) and long-term renal injury.
Results: Among 15,621 patients analyzed, 3% had postoperative stage I kidney injury. Long-term renal outcomes were not similar in patients with and without postoperative stage I injury. Specifically, about 26% of patients with stage I postoperative kidney injury still had mild injury 1 to 2 yr later, and 11% had even more severe injury. A full third (37%) of patients with stage I kidney injury therefore had renal injury 1 to 2 yr after surgery. Patients with postoperative stage I injury had an estimated 2.4 times higher odds of having long-term renal dysfunction (KDIGO stage I, II, or III) compared with patients without postoperative kidney injury (odds ratio [95% CI] of 2.4 [2.0 to 3.0]) after adjustment for potential confounding factors.
Conclusions: In adults recovering from noncardiac surgery, even small postoperative increases in plasma creatinine, corresponding to stage I kidney injury, are associated with renal dysfunction 1 to 2 yr after surgery. Even mild postoperative renal injury should therefore be considered a clinically important perioperative outcome.
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翻译：何幼芹 编辑：冯玉蓉 审校：王贵龙