Association of intraoperative hypotension with acute kidney injury after liver resection surgery: an observational cohor
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RESEARCH ARTICLE
Open Access
Association of intraoperative hypotension with acute kidney injury after liver resection surgery: an observational cohort study Pingping Liao1†, Shuo Zhao2†, Lin Lyu2,3*†, Xuanlong Yi2, Xiangyu Ji2, Jian Sun2, Yanfang Jia2 and Zangong Zhou2*†
Abstract Background: Acute kidney injury (AKI) is a major complication following liver resection. The aim of this study was to determine the risk factors for AKI after hepatic resection and whether intraoperative hypotension (IOH) was related to AKI. Methods: Adult patients (≥ 18 years) undergoing liver resection between November 2017 and November 2019 at our hospital were retrospectively reviewed. AKI was defined as ≥50% increase in serum creatinine from baseline value within 48 h after surgery. IOH was defined as the lowest absolute mean arterial pressure (MAP) < 65 mmHg for more than 10 cumulative minutes during the surgery. Patients were divided into AKI group and non-AKI group, and were stratified by age ≥ 65 years. Results: 796 patients who met our inclusion and exclusion criteria were analyzed. After multivariable regression analysis, the IOH (OR, 2.565; P = 0.009) and age ≥ 65 years (OR, 2.463; P = 0.008) were risk factors for AKI. The IOH (OR, 3.547; P = 0.012) and received red blood cell (OR, 3.032; P = 0.036) were risk factors of AKI in age ≥ 65 years patients. Conclusions: The IOH and age ≥ 65 years were risk factors for postoperative AKI, and IOH was associated with AKI in age ≥ 65 years patients following liver resection. Keywords: Acute kidney injury, Intraoperative hypotension, Liver resection
Background Postoperative acute kidney injury (AKI) is a major complication following liver resection, of which the incidence is reported approximately 8.7–15% [1, 2]. AKI in patients who have undergone liver resection is associated with prolonged hospital stay and hospital mortality [3] . As similar to AKI following other type of surgeries [4], AKI following
* Correspondence: [email protected]; [email protected] † Pingping Liao and Shuo Zhao contributed equally to this work and should be regarded as co-first authors. † Lin Lyu and Zangong Zhou contributed equally to this work and should be regarded as co-corresponding authors. 2 Department of Anesthesiology, the Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao 266000, Shandong, China Full list of author information is available at the end of the article
liver resection also increases the risk of mortality or developing chronic kidney disease (CKD) in the long term [5]. Many factors inducing renal cycles of ischemia and reperfusion during surgery lead to postoperative AKI, including high rates and volumes of blood product transfusion or infused fluid, use of vasopressors and blood loss etc. [6]. It is proposed that intraoperative hypotension (IOH) resulting in disruption of renal perfusion may induce AKI [7]. As revealed by many studies, intraoperative decreased mean arterial pressure (MAP) was associated with postoperative AKI [8, 9]. Liver resection surgery is one
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