Acute Renal Injury In Diabetic Patients After Surgery:Prevalence,Risk Factors And Prediction Model

Objective: To investigate the prevalence of acute renal injury(AKI)in patients with type 2 diabetes mellitus(DM)after elective surgery,analyze the possible risk factors,and build a prediction model of AKI.Methods: the clinical data of patients with type 2 diabetes who received surgery in the First Affiliated Hospital of Guangxi Medical University from January 1,2018 to December 30,2018 were retrospectively analyzed.The incidence of AKI at 7 days after surgery was investigated.The independent risk factors of AKI were analyzed by binary logistic regression analysis,and the prediction model of AKI was constructed by R language.Results: 582 patients with type 2 DM who underwent surgery were included in the analysis.46 patients developed AKI within 7 days after surgery.The prevalence of AKI was 7.9%(46 / 582).There were 31 cases of stage 1 AKI,9 cases of stage 2 AKI and 6 cases of stage 3 AKI.The highest incidence of AKI was cardiac surgery.Other types of surgery include orthopedics,craniocerebral surgery,general surgery,Urology,otorhinolaryngology and vascular surgery.Logistic regression analysis showed that the independent risk factors of AKI included high preoperative NLR(P = 0.008;or = 1.094,95% CI: 1.024-1.169),history of hypertension(P = 0.039;or = 2.198,95% CI: 1.040-4.642),history of coronary heart disease(P = 0.001;or = 3.577,95% CI: 1.646-7.771),use of diuretics(P = < 0.001;or = 7.269,95% CI: 3.349-15.775)and operation type(P= 0.001;or = 4.552,95% CI: 1.788-11.442).The c-index of AKI was 0.86(95%CI: 0.80-0.92),and the correction curve was close to the 45 ° reference line.Conclusion: AKI is a common short-term complication in type 2 DM patients,especially in type 2 DM patients receiving cardiac surgery,NLR,cardiovascular complications and the use of diuretics are important factors that affect the occurrence of AKI.Attention to high-risk groups such as hypertension and coronary heart disease during perioperative period,monitoring the change of NLR and careful use of diuretics may help to reduce the risk of AKI.Based on the independent risk factors,the prediction nomogram of AKI in diabetic patients after surgery can help to predict the risk of AKI in clinical practice.