Incidence, risk factors, and prognostic impact of acute kidney injury in critically ill patients after craniotomy

doi:10.3877/cma.j.issn.2096-1537.2024.02.009

Abstract

Abstract:

Objective

To investigate the incidence, risk factors and prognosis of acute kidney injury (AKI) in critically ill patients after craniotomy.

Methods

This was a single-center prospective cohort study. Adult patients who were admitted to ICU from January 2017 to December 2018 after undergoing craniotomy and had a ICU length of stay ≥ 24 hours were included. Patients with preoperative AKI were excluded from the study. Demographics, primary diagnosis, disease severity scores, complications, and the recovery of renal function in AKI patients were recorded. All patients were followed until discharge, and information about prognosis was recorded. A multivariate regression analysis was used to identify the risk factors for AKI.

Results

A total of 907 patients were included, with 143 (15.8%) developing AKI. Multivariable regression analysis identified a low baseline estimated glomerular filtration rate (eGFR), a high sequential organ failure assessment (SOFA) score on ICU admission day, shock, and hypernatremia as independent risk factors for AKI. Moreover, patients with AKI had longer ICU LOS [10 (5, 19) d vs 5 (3, 12) d, Z=5.836, P<0.001] and mechanical ventilation duration [7 (3, 12) d vs 4 (1, 8) d, Z=1.193, P<0.001], higher in-hospital mortality rates (30.8% vs 6.2%, χ²=80.87, P<0.001), and lower Glasgow outcome scale (GOS) [3 (2, 4) points vs 4 (3, 5) points, Z=1.181, P<0.001] at discharge.

Conclusion

AKI is relatively common in critically ill post-craniotomy patients, with eGFR, SOFA score, shock, and hypernatremia being independent risk factors. Patients with AKI have worse outcomes.

Key words: Acute kidney injury, Post-craniotomy, Incidence, Risk factors, Prognosis

Jianfang Zhou, Xuying Luo, Linlin Zhang, Hongliang Li, Yanlin Yang, Guangqiang Chen, Guangzhi Shi. Incidence, risk factors, and prognostic impact of acute kidney injury in critically ill patients after craniotomy[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2024, 10(02): 148-156.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2024.02.009

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References 34

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性别	Scr（mg/dl）	公式
女性	≤0.7	GFR=144×（Scr/0.7）^-0.329×0.993^年龄
	>0.7	GFR=144×（Scr/0.7）^-1.209×0.993^年龄
男性	≤0.9	GFR=141×（Scr/0.9）^-0.411×0.993^年龄
	>0.9	GFR=141×（Scr/0.7）^-1.209×0.993^年龄

性别	Scr（mg/dl）	公式
女性	≤0.7	GFR=144×（Scr/0.7）^-0.329×0.993^年龄
	>0.7	GFR=144×（Scr/0.7）^-1.209×0.993^年龄
男性	≤0.9	GFR=141×（Scr/0.9）^-0.411×0.993^年龄
	>0.9	GFR=141×（Scr/0.7）^-1.209×0.993^年龄

变量	所有患者（907例）	AKI（143例）	非AKI（764例）	χ²值	P值
基本情况
男性	505（55.7）	88（61.5）	417（54.6）	2.363	0.142
年龄[岁，M（Q₂₅，Q₇₅）]	50（39，60）	56（40，63）	50（38，59）	Z=2.346	0.071
吸烟	156（17.2）	29（20.3）	127（16.6）	1.131	0.280
酗酒	94（10.4）	14（9.8）	80（10.5）	0.060	0.882
基础疾病
高血压	259（28.6）	51（35.7）	208（27.2）	4.205	0.044
糖尿病	90（9.9）	15（10.5）	75（9.8）	0.061	0.762
脑血管疾病	71（7.8）	15（10.5）	56（7.3）	1.667	0.233
肿瘤	42（4.6）	9（6.3）	33（4.3）	1.063	0.283
冠心病	35（3.9）	5（3.5）	30（3.9）	0.060	1.000
手术类型				0.422	0.509
择期手术	710（78.3）	109（76.2）	601（78.7）
急诊手术	197（21.7）	34（23.8）	163（21.3）
手术部位				1.292	0.256
幕上手术	519（57.2）	88（61.5）	431（56.4）
幕下手术	388（42.8）	55（38.5）	333（43.6）
手术指征
颅内肿瘤	547（60.3）	77（53.8）	470（61.5）	2.962	0.094
脑血管疾病	217（23.9）	46（32.2）	171（22.4）	7.337	0.014
TBI	105（11.6）	15（10.5）	90（11.8）	0.196	0.776
其他原因	38（4.2）	5（3.5）	33（4.3）	0.203	0.821

变量	所有患者（907例）	AKI（143例）	非AKI（764例）	χ²值	P值
基本情况
男性	505（55.7）	88（61.5）	417（54.6）	2.363	0.142
年龄[岁，M（Q₂₅，Q₇₅）]	50（39，60）	56（40，63）	50（38，59）	Z=2.346	0.071
吸烟	156（17.2）	29（20.3）	127（16.6）	1.131	0.280
酗酒	94（10.4）	14（9.8）	80（10.5）	0.060	0.882
基础疾病
高血压	259（28.6）	51（35.7）	208（27.2）	4.205	0.044
糖尿病	90（9.9）	15（10.5）	75（9.8）	0.061	0.762
脑血管疾病	71（7.8）	15（10.5）	56（7.3）	1.667	0.233
肿瘤	42（4.6）	9（6.3）	33（4.3）	1.063	0.283
冠心病	35（3.9）	5（3.5）	30（3.9）	0.060	1.000
手术类型				0.422	0.509
择期手术	710（78.3）	109（76.2）	601（78.7）
急诊手术	197（21.7）	34（23.8）	163（21.3）
手术部位				1.292	0.256
幕上手术	519（57.2）	88（61.5）	431（56.4）
幕下手术	388（42.8）	55（38.5）	333（43.6）
手术指征
颅内肿瘤	547（60.3）	77（53.8）	470（61.5）	2.962	0.094
脑血管疾病	217（23.9）	46（32.2）	171（22.4）	7.337	0.014
TBI	105（11.6）	15（10.5）	90（11.8）	0.196	0.776
其他原因	38（4.2）	5（3.5）	33（4.3）	0.203	0.821

变量	所有患者（907例）	AKI（143例）	非AKI（764例）	统计值	P值
基础肌酐[μmol/L，M（Q₂₅，Q₇₅）]	58.3（48.2，70.0）	69.8（58.0，81.1）	56.4（47.2，67.5）	Z=7.814	<0.001
基础eGFR[ml/（min·1.73m²），M（Q₂₅，Q₇₅）]	111.8（97.1，130.4）	97.4（83.7，112.3）	115.6（100.5，132.6）	Z=7.666	<0.001
术前血清白蛋白[g/L，M（Q₂₅，Q₇₅）]	44.4（40.2，47.0）	42.4（39.7，45.3）	44.8（41.1，47.2）	Z=5.169	<0.001
术前应用ACEI/ARB[例（%）]	42（4.6）	11（7.7）	31（4.1）	χ²=3.603	0.058
术前应用碘造影剂[例（%）]	77（8.5）	20（14.0）	57（7.5）	χ²=6.602	0.010
术中输注红细胞[例（%）]	79（8.7）	16（11.2）	63（8.2）	χ²=0.252	0.252
术中输注血浆[例（%）]	80（8.8）	13（9.1）	67（8.8）	χ²=0.901	0.901

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