Risk Factors Of Acute Kidney Injury After Emergency Abdominal Surgery

Background:To investigate the risk factors of acute kidney injury(AKI)and prognosis in critically ill patients after emergency abdominal surgery and to analyze the predictive value of related risk factors.Methods:The clinical data of 140 patients admitted to the intensive care unit(ICU)after emergency abdominal surgery in the Emergency Surgery Department of the First Affiliated Hospital of Nanchang University from September 2020 to August 2022 were retrospectively analyzed.The diagnosis and classification of AKI were based on the international Kidney Disease Improving Global Outcomes(KDIGO)standard.According to whether AKI occurred after surgery,the patients were divided into the AKI group(n=59)and the non-AKI group(n=81).The prognosis was divided into(1)AKI patients were divided into the AKI stage I group(n=45)and AKI stage II-III group(n=14)according to KDIGO criteria.(2)The AKI patients were divided into a recovery group(n=49)and a non-recovery group(n=10)according to the creatinine level returning to preoperative level within seven days after the operation.(3)The patients were divided into a death group(n=17)and a survival group(n=123)according to the outcome of discharge.The patient’s age,gender,primary diseases,American Society of Anesthesiologists(ASA)classification,serum creatinine(Scr),preoperative and postoperative albumin(Alb),preoperative and postoperative hemoglobin(Hb)before and seven days after the operation were collected.Neutrophil gelatinase-associated lipocalin(NGAL)level,Anesthesia method,Operation time,intraoperative fluid loss,intraoperative urine volume,and other clinical data Binary Logistic regression was used to analyze the risk factors of postoperative AKI and prognosis,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of risk factors for postoperative AKI and prognosis.Results:A total of 140 patients admitted to the ICU after emergency abdominal surgery were included in this study to analyze postoperative AKI and its prognostic risk factors.The overall incidence of postoperative AKI was 42.14%(59/140),of which AKI grade I accounted for 76.27%(45/59),AKI grade II accounted for 18.64%(11/59),and AKI grade III accounted for 5.09(3/59).ASA grade IV and neutrophil gelatinase-associated lipid carrier protein(NGAL)are independent risk factors for postoperative AKI.The probability of AKI in patients with ASA grade IV～V is seven times higher than in patients with ASA grade III(95% CI: 2.814-17.461,P<0.05).The area under the curve(AUC)of NGAL predicting postoperative AKI was 0.688(95%CI: 0.549-0.828,P=0.014),and the best cutoff value was 501.0 ng/m L(sensitivity67.7%,specificity 74.1%).The incidence of death at the end of discharge was 12.14%(17/140),of which 70.59%(12/17)were diagnosed with postoperative AKI,and29.41%(5/17)did not meet the AKI standard.However,ASA grade III,preoperative creatinine,and AKI failure to recover are independent risk factors for the death and discharge outcome of patients.ASA grade IV～V is 11 times the probability of death of ASA grade III(95% CI: 1.891-63.191,P=0.007),and AKI failure to recover within seven days after an operation is 87.6 times the probability of death of AKI recovery(95% CI: 6.196-1238.957,P=0.001).The AUC of preoperative creatinine predicting patients’ death and discharge outcome is 0.707(95% CI: 0.559-0.855,P=0.006);the best cutoff value is 105.80μmol/L(sensitivity 47.1%,specificity 90.2%).Conclusions:1.Higher ASA grade and NGAL test index may influence postoperative AKI,and both have good predictive value for the occurrence and development of postoperative AKI.2.ASA grade IV～V,high serum creatinine before the operation,and no recovery of AKI within seven days after the operation may be high-risk factors for the death and discharge of patients.