Elevated De Ritis Ratio as a Predictor for Acute Kidney Injury after Radical Retropubic Prostatectomy.

Jun-Young Park,Jihion Yu,Jai-Hyun Hwang,Youngdo Kim,Young-Kug Kim,Bumjin Lim,Jun Hyuk Hong

doi:10.3390/jpm11090836

Jun-Young Park, Jihion Yu + Show 5 more

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https://doi.org/10.3390/jpm11090836

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Abstract

Acute kidney injury (AKI) is related to mortality and morbidity. The De Ritis ratio, calculated by dividing the aspartate aminotransferase by the alanine aminotransferase, is used as a prognostic indicator. We evaluated risk factors for AKI after radical retropubic prostatectomy (RRP). This retrospective study included patients who performed RRP. Multivariable logistic regression analysis and a receiver operating characteristic (ROC) curve analysis were conducted. Other postoperative outcomes were also evaluated. Among the 1415 patients, 77 (5.4%) had AKI postoperatively. The multivariable logistic regression analysis showed that estimated glomerular filtration rate, albumin level, and the De Ritis ratio at postoperative day 1 were risk factors for AKI. The area under the ROC curve of the De Ritis ratio at postoperative day 1 was 0.801 (cutoff = 1.2). Multivariable-adjusted analysis revealed that the De Ritis ratio at ≥1.2 was significantly related to AKI (odds ratio = 8.637, p < 0.001). Postoperative AKI was associated with longer hospitalization duration (11 ± 5 days vs. 10 ± 4 days, p = 0.002). These results collectively show that an elevated De Ritis ratio at postoperative day 1 is associated with AKI after RRP in patients with prostate cancer.

Highlights

Radical prostatectomy is known to be a mainstay of treatment in patients with prostate cancer [1]
A review of medical records led to the identification of 1606 patients who had performed retropubic prostatectomy (RRP) between January 2009 and November 2020
We demonstrate that a De Ritis ratio ≥ 1.2 at postoperative day 1 is significantly related to a higher risk of acute kidney injury (AKI) after RRP and that hospitalization duration was significantly longer in patients who suffered postoperative AKI

Summary

Introduction

Radical prostatectomy is known to be a mainstay of treatment in patients with prostate cancer [1]. Even if robotic or laparoscopic approaches for radical prostatectomy have become increasingly popular, radical retropubic prostatectomy (RRP) is still widely performed, especially in prostate cancer patients with optic neuropathy, increased intracranial pressure, or severe obstructive lung disease [2]. Complications of RRP include bleeding, urinary tract infection, bladder neck contracture, erectile dysfunction, and urinary incontinence [3]. Postoperative acute kidney injury (AKI) is another frequent complication of RRP, with an incidence of 10.4% [4]. Postoperative AKI has been found to be related to progressive chronic kidney disease, prolonged hospitalization duration, higher medical costs, and increased mortality [5].

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