Abstract: SA-PO195
AKI in Critically Ill Patients After Oncological Surgery: Risk Factors and Mortality
Session Information
- Onco-Nephrology: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Cordova-Sanchez, Bertha M., Instituto Nacional de Cancerologia, Mexico, Mexico
- Ñamendys- Silva, Silvio A., Instituto Nacional de Cancerologia, Mexico, Mexico
Background
Acute kidney injury (AKI) is a frequent complication in critically ill patients, major surgery is the second most important cause of AKI. In cancer patients AKI is associated with increased mortality, therefore it is necessary to identify modifiable risk factors for its prevention. Previous scores aimed to predict AKI in general surgery have shown poor predictive value in patients undergoing oncological surgery, possibly because these scores do not consider previously administered radiotherapy or chemotherapy. The aim of this study was to evaluate the incidence, mortality and risk factors for AKI development, defined by KDIGO criteria in patients admitted to the intensive care unit (ICU) in the first 24 hours after major oncological surgery.
Methods
We conducted a retrospective analysis using a logistic regression model to evaluate the association between preoperative and intraoperative variables with AKI, and a Cox regression model to evaluate factors associated with 12-month mortality.
Results
We included 434 patients, with a median follow-up of 432 days. We included 171 men (39%), with a median age of 53 years (IQR 41-63). All patients had solid tumors, most from gastrointestinal origin (124 patients, 29%) and female reproductive system (98 patients, 23%), and 294 (68%) underwent abdominal surgery. We diagnosed AKI in 264 (60.8%) patients: 135 (31.1%) stage-1, 66 (15.2%) stage-2 and 63 (14.5%) stage-3 AKI. In multivariate analysis, abdominal radiotherapy (OR 2.57, 95%CI 1.25-5.29, p=0.010), abdominal surgery (OR 2.46, 95%CI 1.31-4.62, p=0.005), surgical packing (OR 4.12, 95%CI 1.97-8.61, p=0.000) and sepsis (OR 2.39, 95%CI 1.31-4.37, p=0.005) were independent risk factors for AKI development, while pre-surgical albumin (OR 0.45 95%CI 0.32-0.63, p=0.000) and intraoperative urine output (OR 0.81, 95%CI 0.70-0-94, p=0.006) were protective factors.
During the 12-month follow-up 108 died, and stage 2 (HR 2.90, 95%CI 1.47-5.73, p=0.002) and stage 3 AKI (HR 5.85, 95%CI 2.89-11.88, p=0.000) were associated with mortality.
Conclusion
Almost 30% of patients developed stage 2 and 3 AKI, and the associated risk factors were abdominal radiotherapy, abdominal surgery, surgical packing and sepsis. Stage 2 and 3 AKI were associated with 12-month mortality.