Intraoperative oliguria predicts acute kidney injury after major abdominal surgery
The threshold of intraoperative urine output below which the risk of acute kidney injury (AKI) increases is unclear. The aim of this retrospective cohort study was to investigate the relationship between intraoperative urine output during major abdominal surgery and the development of postoperative...
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| Veröffentlicht in: | British journal of anaesthesia : BJA 2017-12, Vol.119 (6), p.1127-1134 |
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| creator | Mizota, T. Yamamoto, Y. Hamada, M. Matsukawa, S. Shimizu, S. Kai, S. |
| description | The threshold of intraoperative urine output below which the risk of acute kidney injury (AKI) increases is unclear. The aim of this retrospective cohort study was to investigate the relationship between intraoperative urine output during major abdominal surgery and the development of postoperative AKI and to identify an optimal threshold for predicting the differential risk of AKI.
Perioperative data were collected retrospectively on 3560 patients undergoing major abdominal surgery (liver, colorectal, gastric, pancreatic, or oesophageal resection) at Kyoto University Hospital. We evaluated the relationship between intraoperative urine output and the development of postoperative AKI as defined by recent guidelines. Logistic regression analysis was performed to adjust for patient and operative variables, and the minimum P-value approach was used to determine the threshold of intraoperative urine output that independently altered the risk of AKI.
The overall incidence of AKI in the study population was 6.3%. Using the minimum P-value approach, a threshold of 0.3 ml kg−1 h−1 was identified, below which there was an increased risk of AKI (adjusted odds ratio, 2.65; 95% confidence interval, 1.77–3.97; P |
| doi_str_mv | 10.1093/bja/aex255 |
| format | Article |
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Perioperative data were collected retrospectively on 3560 patients undergoing major abdominal surgery (liver, colorectal, gastric, pancreatic, or oesophageal resection) at Kyoto University Hospital. We evaluated the relationship between intraoperative urine output and the development of postoperative AKI as defined by recent guidelines. Logistic regression analysis was performed to adjust for patient and operative variables, and the minimum P-value approach was used to determine the threshold of intraoperative urine output that independently altered the risk of AKI.
The overall incidence of AKI in the study population was 6.3%. Using the minimum P-value approach, a threshold of 0.3 ml kg−1 h−1 was identified, below which there was an increased risk of AKI (adjusted odds ratio, 2.65; 95% confidence interval, 1.77–3.97; P<0.001). The addition of oliguria <0.3 ml kg−1 h−1 to a model with conventional risk factors significantly improved risk stratification for AKI (net reclassification improvement, 0.159; 95% confidence interval, 0.049–0.270; P=0.005).
Among patients undergoing major abdominal surgery, intraoperative oliguria <0.3 ml kg−1 h−1 was significantly associated with increased risk of postoperative AKI.</description><identifier>ISSN: 0007-0912</identifier><identifier>EISSN: 1471-6771</identifier><identifier>DOI: 10.1093/bja/aex255</identifier><identifier>PMID: 29136086</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Abdomen - surgery ; acute kidney injury ; Acute Kidney Injury - diagnosis ; Acute Kidney Injury - urine ; Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Female ; general surgery ; Humans ; intraoperative ; Intraoperative Complications - urine ; Male ; Middle Aged ; monitoring ; oliguria ; Oliguria - urine ; Postoperative Complications - diagnosis ; Postoperative Complications - urine ; Retrospective Studies ; Risk Factors ; Young Adult</subject><ispartof>British journal of anaesthesia : BJA, 2017-12, Vol.119 (6), p.1127-1134</ispartof><rights>2017 The Author(s)</rights><rights>The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com 2017</rights><rights>The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c508t-3697a1202399e0cd202ff9bccbe28df2c85f6d5a5c1481898c76177e56d373813</citedby><cites>FETCH-LOGICAL-c508t-3697a1202399e0cd202ff9bccbe28df2c85f6d5a5c1481898c76177e56d373813</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29136086$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mizota, T.</creatorcontrib><creatorcontrib>Yamamoto, Y.</creatorcontrib><creatorcontrib>Hamada, M.</creatorcontrib><creatorcontrib>Matsukawa, S.</creatorcontrib><creatorcontrib>Shimizu, S.</creatorcontrib><creatorcontrib>Kai, S.</creatorcontrib><title>Intraoperative oliguria predicts acute kidney injury after major abdominal surgery</title><title>British journal of anaesthesia : BJA</title><addtitle>Br J Anaesth</addtitle><description>The threshold of intraoperative urine output below which the risk of acute kidney injury (AKI) increases is unclear. The aim of this retrospective cohort study was to investigate the relationship between intraoperative urine output during major abdominal surgery and the development of postoperative AKI and to identify an optimal threshold for predicting the differential risk of AKI.
Perioperative data were collected retrospectively on 3560 patients undergoing major abdominal surgery (liver, colorectal, gastric, pancreatic, or oesophageal resection) at Kyoto University Hospital. We evaluated the relationship between intraoperative urine output and the development of postoperative AKI as defined by recent guidelines. Logistic regression analysis was performed to adjust for patient and operative variables, and the minimum P-value approach was used to determine the threshold of intraoperative urine output that independently altered the risk of AKI.
The overall incidence of AKI in the study population was 6.3%. Using the minimum P-value approach, a threshold of 0.3 ml kg−1 h−1 was identified, below which there was an increased risk of AKI (adjusted odds ratio, 2.65; 95% confidence interval, 1.77–3.97; P<0.001). The addition of oliguria <0.3 ml kg−1 h−1 to a model with conventional risk factors significantly improved risk stratification for AKI (net reclassification improvement, 0.159; 95% confidence interval, 0.049–0.270; P=0.005).
Among patients undergoing major abdominal surgery, intraoperative oliguria <0.3 ml kg−1 h−1 was significantly associated with increased risk of postoperative AKI.</description><subject>Abdomen - surgery</subject><subject>acute kidney injury</subject><subject>Acute Kidney Injury - diagnosis</subject><subject>Acute Kidney Injury - urine</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>general surgery</subject><subject>Humans</subject><subject>intraoperative</subject><subject>Intraoperative Complications - urine</subject><subject>Male</subject><subject>Middle Aged</subject><subject>monitoring</subject><subject>oliguria</subject><subject>Oliguria - urine</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - urine</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Young Adult</subject><issn>0007-0912</issn><issn>1471-6771</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90E9LwzAYx_EgipvTiy9AchFEqEvSNWmOMvwHA0H0HNLk6chsm5q0w717K52exFNy-Dy_wxehc0puKJHpvNjouYZPlmUHaEoXgiZcCHqIpoQQkRBJ2QSdxLghhAoms2M0YZKmnOR8il6emi5o30LQndsC9pVb98Fp3AawznQRa9N3gN-dbWCHXbPpww7rsoOAa73xAevC-to1usKxD2sIu1N0VOoqwtn-naG3-7vX5WOyen54Wt6uEpORvEtSLoWmjLBUSiDGDr-ylIUxBbDclszkWcltpjNDFznNZW4Ep0JAxm0q0pymM3Q17rbBf_QQO1W7aKCqdAO-j4pKvhCEEsYHej1SE3yMAUrVBlfrsFOUqO-GamioxoYDvtjv9kUN9pf-RBvA5Qh83_4_tBgdDBW2DoKKxkFjhrABTKesd3-dfQEl1I0a</recordid><startdate>201712</startdate><enddate>201712</enddate><creator>Mizota, T.</creator><creator>Yamamoto, Y.</creator><creator>Hamada, M.</creator><creator>Matsukawa, S.</creator><creator>Shimizu, S.</creator><creator>Kai, S.</creator><general>Elsevier Ltd</general><general>Oxford University Press</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201712</creationdate><title>Intraoperative oliguria predicts acute kidney injury after major abdominal surgery</title><author>Mizota, T. ; Yamamoto, Y. ; Hamada, M. ; Matsukawa, S. ; Shimizu, S. ; Kai, S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c508t-3697a1202399e0cd202ff9bccbe28df2c85f6d5a5c1481898c76177e56d373813</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Abdomen - surgery</topic><topic>acute kidney injury</topic><topic>Acute Kidney Injury - diagnosis</topic><topic>Acute Kidney Injury - urine</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>general surgery</topic><topic>Humans</topic><topic>intraoperative</topic><topic>Intraoperative Complications - urine</topic><topic>Male</topic><topic>Middle Aged</topic><topic>monitoring</topic><topic>oliguria</topic><topic>Oliguria - urine</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - urine</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mizota, T.</creatorcontrib><creatorcontrib>Yamamoto, Y.</creatorcontrib><creatorcontrib>Hamada, M.</creatorcontrib><creatorcontrib>Matsukawa, S.</creatorcontrib><creatorcontrib>Shimizu, S.</creatorcontrib><creatorcontrib>Kai, S.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of anaesthesia : BJA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mizota, T.</au><au>Yamamoto, Y.</au><au>Hamada, M.</au><au>Matsukawa, S.</au><au>Shimizu, S.</au><au>Kai, S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intraoperative oliguria predicts acute kidney injury after major abdominal surgery</atitle><jtitle>British journal of anaesthesia : BJA</jtitle><addtitle>Br J Anaesth</addtitle><date>2017-12</date><risdate>2017</risdate><volume>119</volume><issue>6</issue><spage>1127</spage><epage>1134</epage><pages>1127-1134</pages><issn>0007-0912</issn><eissn>1471-6771</eissn><abstract>The threshold of intraoperative urine output below which the risk of acute kidney injury (AKI) increases is unclear. The aim of this retrospective cohort study was to investigate the relationship between intraoperative urine output during major abdominal surgery and the development of postoperative AKI and to identify an optimal threshold for predicting the differential risk of AKI.
Perioperative data were collected retrospectively on 3560 patients undergoing major abdominal surgery (liver, colorectal, gastric, pancreatic, or oesophageal resection) at Kyoto University Hospital. We evaluated the relationship between intraoperative urine output and the development of postoperative AKI as defined by recent guidelines. Logistic regression analysis was performed to adjust for patient and operative variables, and the minimum P-value approach was used to determine the threshold of intraoperative urine output that independently altered the risk of AKI.
The overall incidence of AKI in the study population was 6.3%. Using the minimum P-value approach, a threshold of 0.3 ml kg−1 h−1 was identified, below which there was an increased risk of AKI (adjusted odds ratio, 2.65; 95% confidence interval, 1.77–3.97; P<0.001). The addition of oliguria <0.3 ml kg−1 h−1 to a model with conventional risk factors significantly improved risk stratification for AKI (net reclassification improvement, 0.159; 95% confidence interval, 0.049–0.270; P=0.005).
Among patients undergoing major abdominal surgery, intraoperative oliguria <0.3 ml kg−1 h−1 was significantly associated with increased risk of postoperative AKI.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>29136086</pmid><doi>10.1093/bja/aex255</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Abdomen - surgery acute kidney injury Acute Kidney Injury - diagnosis Acute Kidney Injury - urine Adult Aged Aged, 80 and over Cohort Studies Female general surgery Humans intraoperative Intraoperative Complications - urine Male Middle Aged monitoring oliguria Oliguria - urine Postoperative Complications - diagnosis Postoperative Complications - urine Retrospective Studies Risk Factors Young Adult |
| title | Intraoperative oliguria predicts acute kidney injury after major abdominal surgery |
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