Effect of cumulative fluid balance on acute kidney injury and patient outcomes after orthotopic liver transplantation: A retrospective cohort study

Zhang, Simei; Ma, Jiguang; An, Rui; Lin, Li; Li, Jianpeng; Fang, Zeping; Wei, Qiang; Ma, Qingyong; Shen, Xiongjie

doi:10.1111/nep.13702

Cited by 14 publications

(13 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patients with sepsis and mechanical ventilation at ICU admission had an increased risk for developing AKI, which has been previously reported in critically ill patients 1,2 . In our patients, albumin level before surgery showed a protective effect for developing AKI, this finding is consistent with previous reports in different types of surgery 25,26,27 …”

Section: Discussionsupporting

confidence: 92%

Acute kidney injury in critically ill patients after oncological surgery: Risk factors and 1‐year mortality

et al. 2021

View full text Add to dashboard Cite

Aim We aimed to identify risk factors associated with acute kidney injury (AKI) and to analyse 1‐year mortality after oncological surgery. Methods We retrospectively included 434 adult patients admitted to the intensive care unit (ICU) after oncological surgery, and classified AKI according to the Kidney Disease: Improving Global Outcomes criteria. We performed logistic regression and Cox regression analyses to evaluate AKI and mortality risk factors. Results Sixty‐one percent of patients (n = 264) developed AKI. Previous abdominal radiotherapy and abdominal surgical packing were independently associated with stage 2 and 3 AKI, with adjusted odds ratio (OR) of 2.6 (95% confidence interval [CI] 1.3–5.5, p = .010) and OR of 2.6 (95% CI 1.2–5.5, p = .014), respectively. Other independent risk factors were: glomerular filtration rate (eGFR) <60 ml/min/1.73m2 (OR 3.6, 95% CI 1.2–11.4, p = .028), abdominal surgery 2.6 (1.4–4.9, p = .003), intraoperative diuresis <1 ml/k/h (OR 2.4, 95% CI 1.4–4.0, p = .001), sepsis (OR 2.5, 95% CI 1.3–4.6, p = .002) and mechanical ventilation at ICU admission (OR 7.7, 95% CI 3.2–18.6, p < .001). Stage 2 and stage 3 AKI were independently associated with 1‐year mortality, with adjusted hazard ratios (HR) of 2.6 (95% CI 1.3–5.0, p = .005) and HR of 5.0 (95% CI 2.6–9.6, p < .001), respectively. Additionally, patients who had postsurgical AKI, had a lower eGFR at 1‐year follow‐up. These findings may be limited by the retrospective single centre design of our study. Conclusion In addition to the conventional risk factors, our results suggest that abdominal radiotherapy and abdominal surgical packing could be independent risk factors for AKI after oncological surgery.

show abstract

Section: Discussionsupporting

confidence: 92%

Acute kidney injury in critically ill patients after oncological surgery: Risk factors and 1‐year mortality

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Not surprisingly, these four studies confirm what physiology tells us: to achieve a predefined hemodynamic target, a smaller volume of colloid solution, namely HES 130/0.4, is required, compared to crystalloid solution, resulting in a less positive intraoperative fluid balance. Of note, several studies have reported an association between positive perioperative fluid balance and worse outcome [77][78][79][80]. However, among the four studies cited above, our study reported a reduced incidence of postoperative complications with the use of HES solution, associated with a lower intraoperative fluid balance [57].…”

Section: Yesmentioning

confidence: 41%

Hydroxyethyl starch for perioperative goal-directed fluid therapy in 2020: a narrative review

et al. 2020

View full text Add to dashboard Cite

Background: Perioperative fluid managementincluding the type, dose, and timing of administration-directly affects patient outcome after major surgery. The objective of fluid administration is to optimize intravascular fluid status to maintain adequate tissue perfusion. There is continuing controversy around the perioperative use of crystalloid versus colloid fluids. Unfortunately, the importance of fluid volume, which significantly influences the benefit-to-risk ratio of each chosen solution, has often been overlooked in this debate. Main text: The volume of fluid administered during the perioperative period can influence the incidence and severity of postoperative complications. Regrettably, there is still huge variability in fluid administration practices, both intra-and inter-individual, among clinicians. Goal-directed fluid therapy (GDFT), aimed at optimizing flowrelated variables, has been demonstrated to have some clinical benefit and has been recommended by multiple professional societies. However, this approach has failed to achieve widespread adoption. A closed-loop fluid administration system designed to assist anesthesia providers in consistently applying GDFT strategies has recently been developed and tested. Such an approach may change the crystalloid versus colloid debate. Because colloid solutions have a more profound effect on intravascular volume and longer plasma persistence, their use in this more "controlled" context could be associated with a lower fluid balance, and potentially improved patient outcome. Additionally, most studies that have assessed the impact of a GDFT strategy on the outcome of high-risk surgical patients have used hydroxyethyl starch (HES) solutions in their protocols. Some of these studies have demonstrated beneficial effects, while none of them has reported severe complications.

show abstract

“…In this study, preoperative serum albumin was not an independent predictor, while preoperative prealbumin showed a strong ability to predict the risk of postoperative complications. Although preoperative albumin is a widely used indicator to evaluate nutritional status and liver function [ 20 , 21 ], a moderate positive correlation with preoperative prealbumin was also exhibited in scatter plots based on Spearman correlation analysis (R = 0.703, P < 0.001). A remarkable finding was that patients frequently received peripheral supplemental infusion of albumin solution due to continuous deterioration of nutritional status and ascites.…”

Section: Discussionmentioning

confidence: 99%

Low preoperative prealbumin predicts the prevalence of complications following liver transplantation

Liu

Jiang

et al. 2021

BMC Gastroenterol

View full text Add to dashboard Cite

Background As a nutritional index, preoperative serum prealbumin highly correlates with surgical complications. However, the correlation between preoperative prealbumin and postoperative complications remains unclear in liver transplantation (LT). Methods A total of 191 patients who underwent LT between 2015 and 2019 were included in the retrospective analysis. According to a cut-off value calculated from a receiver operating characteristic (ROC) curve, the patients were divided into normal and low preoperative prealbumin groups. Univariable and multivariable logistic regression analyses were used to identify independent risk factors for postoperative complications. In addition, patients were divided into subgroups by Model for End-stage Liver Disease (MELD) score, and the association between preoperative prealbumin and postoperative complications was also assessed in each group. Results A total of 111 (58.1%) patients were included in the low prealbumin group based on a cut-off value of 120 mg/L. The area under the ROC curve (AUC) was 0.754 (95% confidence interval [CI] 0.678–0.832). Low prealbumin (95% CI 1.51–12.8, P = 0.007) was identified as a predictor for postoperative complications based on multivariable regression. In the low and normal prealbumin groups, the prevalence rates of postoperative complications were 27.5% and 8.0% (P = 0.003) in the MELD score ≤ 15 subgroup and 53.3% and 20.0% (P = 0.197) in the MELD score > 15 subgroup, respectively. Conclusions Preoperative prealbumin was associated with postoperative complications in LT, and preoperative nutritional support benefitted postoperative recovery, especially for patients with low MELD scores.

show abstract

Effect of cumulative fluid balance on acute kidney injury and patient outcomes after orthotopic liver transplantation: A retrospective cohort study

Cited by 14 publications

References 29 publications

Acute kidney injury in critically ill patients after oncological surgery: Risk factors and 1‐year mortality

Acute kidney injury in critically ill patients after oncological surgery: Risk factors and 1‐year mortality

Hydroxyethyl starch for perioperative goal-directed fluid therapy in 2020: a narrative review

Low preoperative prealbumin predicts the prevalence of complications following liver transplantation

Contact Info

Product

Resources

About