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| 老年患者胃肠道肿瘤术后急性肾损伤的危险因素 |
| Risk factors of postoperative acute kidney injury in elderly patients with gastrointestinal tumor surgery |
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| DOI：10.12089/jca.2023.01.004 |
| 中文关键词: 老年 胃肠道肿瘤手术 急性肾损伤 危险因素 预测模型 |
| 英文关键词: Aged Gastrointestinal tumor surgery Acute kidney injury Risk factors Prediction model |
| 基金项目:安徽省重点研究与开发计划（201904a07020065） |
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| 中文摘要: |
目的 分析老年患者胃肠道肿瘤术后急性肾损伤（AKI）的危险因素。
方法 回顾性收集2018年9月至2021年12月行胃肠道肿瘤手术的老年患者343例，男251例，女92例，年龄65～85岁，ASA Ⅰ—Ⅲ级。根据术后是否发生AKI分为两组：AKI组（n=63）和非AKI组（n=280）。查阅电子病历系统收集年龄、心功能分级、高血压、糖尿病、冠心病、低蛋白血症、术前1周贫血程度，手术类型、术前肌酐、肾小球滤过率、尿酸和尿素氮水平、术中和术后转归等情况。单因素分析后将P<0.1的变量纳入二元逻辑回归进行多因素分析，筛选AKI的独立预测因素并建立风险预测模型，通过Medcalr软件绘制受试者工作特征（ROC）曲线。
结果 有63例（18.4%）患者发生术后AKI。单因素分析结果显示，与非AKI组比较，AKI组年龄明显增大，心功能分级明显升高，术前高血压、糖尿病、冠心病、低蛋白血症、轻中度贫血比例明显升高（P<0.1）。多因素Logistic回归分析显示，术前高血压（OR=2.119，95%CI 1.181～3.800，P=0.012）、冠心病（OR=2.931，95%CI 1.024～8.386，P=0.045）、低蛋白血症（OR=2.640，95%CI 1.107～6.295，P=0.029）、轻度贫血（OR=3.890，95%CI 1.922～7.875，P<0.001）、中度贫血（OR=3.089，95%CI 1.437～6.637，P=0.004）为术后AKI的独立危险因素，最后根据各独立预测因素建立术后AKI的风险预测模型ROC曲线下面积为0.740（95%CI 0.690～0.785，P<0.001），敏感性为79.4%，特异性为56.1%。
结论 术前存在高血压、冠心病、低蛋白血症、轻中度贫血为胃肠道肿瘤手术老年患者术后AKI的独立危险因素。 |
| 英文摘要: |
Objective To analyze the risk factors of acute kidney injury (AKI) after gastrointestinal tumor surgery in the elderly.
Methods A total of 343 elderly patients, 251 males and 92 females, aged 65-85 years, ASA physical grade Ⅰ-Ⅲ who underwent gastrointestinal tumor surgery from September 2018 to December 2021 were retrospectively collected. According to whether AKI occurred after surgery, the patients were divided into two groups: AKI group (n = 63) and non-AKI group (n = 280). The electronic medical record system was consulted to collect general patient information, including age, cardiac function class, hypertension, diabetes, coronary heart disease, hypoproteinemia, anemia level one week before surgery, surgical site, preoperative creatinine, glomerular filtration rate, uric acid and blood urea nitrogen levels, and intraoperative and postoperative outcomes. After univariate analysis, variables with P < 0.1 were included in binary logistic regression for multivariate analysis. Independent predictors of AKI were screened out to establish a risk prediction model. Receiver operating characteristic curve (ROC) was drawn by Medcalr software.
Results Postoperative AKI occurred in 63 patients (18.4%). The results of univariate analysis showed that compared with the non-AKI group, the AKI group had significantly increased age, significantly increased cardiac function grade, significantly increased the proportion of preoperative hypertension, diabetes and coronary heart disease, and significantly increased the proportion of preoperative hypoproteinemia and mild to moderate anemia (P < 0.1). Multivariate logistic regression analysis showed that, hypertension (OR = 2.119, 95% CI 1.181-3.800, P = 0.012), coronary heart disease (OR = 2.931, 95% CI 1.024-8.386, P = 0.045), hypoproteinemia (OR = 2.640, 95% CI 1.107-6.295, P = 0.029), mild anemia (OR = 3.890, 95% CI 1.922-7.875, P < 0.001), and moderate anemia (OR = 3.089, 95% CI 1.437-6.637, P = 0.004) were independent risk factors for postoperative AKI. A risk prediction model for postoperative AKI was established according to each independent predictor, the established risk prediction the area under the receiver operating characteristic curve (ROC) of the model was 0.740 (95% CI 0.690-0.785, P < 0.001), with a sensitivity of 79.4% and a specificity of 56.1%.
Conclusion Hypertension, coronary heart disease, hypoproteinemia and mild to moderate anemia are independent risk factors for AKI after gastrointestinal tumor surgery in elderly patients. |
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