ACUTE KIDNEY INJURY AFTER SURGERY OF THE ACUTE ABDOMEN: INDEPENDENT RISK PREDICTORS

Abstract

Objective: To identify independent predictors of postoperative acute kidney injury (AKI) in patients undergoing surgery for the acute abdomen. Methods: A comparative cohort study was conducted to evaluate the surgical treatment outcomes for 271 patients with acute abdomen. All patients were admitted to the intensive care unit for postoperative care and management. The primary endpoint of the study was the development of AKI. Receiver operating characteristic (ROC) analysis was performed to evaluate the sensitivity and specificity, integrating categorical and numerical variables in the prediction of AKI. To identify independent predictors of AKI, the adjusted odds ratio was calculated using binary logistic regression analysis, which included statistically significant risk factors. Results: In the first postoperative week, AKI was diagnosed in 69.7% of patients, with 30.2% of these cases classified as stage III, necessitating renal replacement therapy (RRT). Patients with AKI were statistically older, with an average age of 63.2±8.3 years, compared to 58.8±9.6 years for those without AKI (p<0.001). Additionally, patients with AKI were more likely to have identified comorbidities, including type 2 diabetes mellitus (16.9% vs. 4.9%, p=0.007), chronic kidney disease (36.5% vs. 13.4%, p<0.001), obesity (17.5% vs. 7.3%, p=0.029), and obstructive jaundice (39.7% vs. 11.0%, p<0.001). Furthermore, those with AKI had higher preoperative levels of proinflammatory cytokines, such as tumor necrosis factor-α (TNF-α) (31.4±10.9 vs. 27.4±10.0 pg/ml, p=0.005) and C-reactive protein (CRP) (90.9±26.3 vs. 79.4±27.7 mg/l, p=0.001). Binary logistic regression analysis identified independent risk factors for AKI from the statistically significant predictors. The model demonstrated a specificity of 85.4% and a sensitivity of 95.8%. Conclusion: In cases of acute abdomen, independent predictors of AKI in the postoperative period include age over 60 years, a glomerular filtration rate (GFR) of less than 69 ml/min, and obstructive jaundice.

Keywords

• acute kidney injury
• acute abdomen
• postoperative complication
• risk factor
• independent predictor.