Acute kidney injury after hepatectomy can be reasonably predicted after surgery

Abstract

Hepatectomy presents unique challenges potentially heightening acute kidney injury (AKI) risk, but the full spectrum of risk factors has not been identified. Data for hepatectomy patients in the 2016 American College of Surgeons National Surgical Quality Improvement Program (n = 3,814) was randomly split into derivation (70%) and validation (30%) cohorts. AKI was defined as an increase in serum creatinine ≥0.3mg/dl or ≥1.5-fold above the preoperative value within 30days of surgery. Multivariable logistic regression assessed preoperative and intraoperative risk factors for AKI. Of 2,692 patients (derivation cohort), 432 (16%) developed AKI. Risk factors were the following: age (years; adjusted odds ratio [aOR] 1.016 [95% confidence interval 1.006-1.026], female sex (aOR 0.65 [0.51-0.82]), body mass index (kg/m2 ; aOR 1.043 [1.024-1.062]), diabetes (aOR 1.71 [1.31-2.24]), hypertension (aOR 1.66 [1.30-2.13]), hematocrit (%; aOR 0.944 [0.924-0.966]), operative time (min; aOR 1.004 [1.003-1.004]), planned open procedure (aOR 2.00 [1.47-2.73]), and Pringle maneuver (aOR 1.36 [1.07-1.72]). The areas under the curve of the receiver operating characteristic curves were 0.74 (95% CI 0.71-0.76) and 0.71 (95% CI 0.67-0.75) in the derivation and validation cohorts, respectively. Postoperative AKI affects one in six hepatectomy patients; preoperative and intraoperative factors can predict the risk of postoperative AKI.