Risk Factors for and Prognostic Values of Postoperative Acute Kidney Injury After Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Retrospective, Propensity Score-matched Cohort Study of 1312 Patients

Overview

Journal Cancer Med

Specialty Oncology

Date 2022 Dec 15

PMID 36519518

Authors

Yuchen Ji

Yiran Zhou

Ziyun Shen

Haoda Chen

Shulin Zhao

Xiaxing Deng

Baiyong Shen

Affiliations

Soon will be listed here.

Abstract

Background: While an association between postoperative acute kidney injury (AKI) and adverse events exists, the incidence and impact of postoperative AKI after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma remain unclear. This study aimed to diagnose AKI and investigate the risk factors for and prognostic value of postoperative AKI.

Methods: Clinical characteristics of patients who underwent pancreaticoduodenectomy between 2013 and 2020 at a high-volume centre were collected retrospectively. The Kidney Disease Improving Global Outcomes criteria were used to diagnose AKI. A 1:2 propensity score matching (PSM) was used to minimise bias between the AKI and non-AKI groups. Short-term surgical and long-term survival outcomes were compared between groups. Multivariate logistic regression analysis assessed the independent risk factors for AKI development, major complications, and 30-day mortality.

Results: Postoperative AKI occurred in 10.7% of 1312 patients. Total bilirubin level > 250 μmol/L (odds ratio [OR]: 3.24; p < 0.001), estimated glomerular filtration rate < 60 ml/min/1.73 m (OR: 2.30; p = 0.048), and intraoperative estimated blood loss >1000 ml (OR: 2.96; p = 0.001) were independent risk factors for postoperative AKI. After PSM, higher incidences of major complications (p < 0.001) and 30-day mortality (p < 0.001) were observed in the AKI group than in the non-AKI group. There was no difference in long-term overall survival outcomes between both groups (p = 0.535). AKI was an independent predictor of major complications (OR: 3.06; p < 0.001) and 30-day mortality (OR: 2.87; p = 0.034).

Conclusions: Postoperative AKI is common after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma and has a predictive effect on major complications and 30-day mortality. Therefore, prevention and proper management of postoperative AKI are required in clinical practice.

Citing Articles

Risk factors for and prognostic values of postoperative acute kidney injury after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: A retrospective, propensity score-matched cohort study of 1312 patients.

Ji Y, Zhou Y, Shen Z, Chen H, Zhao S, Deng X Cancer Med. 2022; 12(7):7823-7834.

PMID: 36519518 PMC: 10134349. DOI: 10.1002/cam4.5543.

References

. Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study. BJS Open. 2018; 2(6):400-410. PMC: 6254006. DOI: 10.1002/bjs5.86. View

Nagle R, Leiby B, Lavu H, Rosato E, Yeo C, Winter J . Pneumonia is associated with a high risk of mortality after pancreaticoduodenectomy. Surgery. 2016; 161(4):959-967. DOI: 10.1016/j.surg.2016.09.028. View

El Nakeeb A, El Sorogy M, Hamed H, Said R, Elrefai M, Ezzat H . Biliary leakage following pancreaticoduodenectomy: Prevalence, risk factors and management. Hepatobiliary Pancreat Dis Int. 2018; 18(1):67-72. DOI: 10.1016/j.hbpd.2018.10.005. View

Wente M, Bassi C, Dervenis C, Fingerhut A, Gouma D, Izbicki J . Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007; 142(5):761-8. DOI: 10.1016/j.surg.2007.05.005. View

Levey A, Bosch J, Lewis J, Greene T, Rogers N, Roth D . A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130(6):461-70. DOI: 10.7326/0003-4819-130-6-199903160-00002. View

Ji Y, Zhou Y, Shen Z, Chen H, Zhao S, Deng X . Risk factors for and prognostic values of postoperative acute kidney injury after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: A retrospective, propensity score-matched cohort study of 1312 patients. Cancer Med. 2022; 12(7):7823-7834. PMC: 10134349. DOI: 10.1002/cam4.5543. View

Khwaja A . KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012; 120(4):c179-84. DOI: 10.1159/000339789. View

Lau D, Pannu N, James M, Hemmelgarn B, Kieser T, Meyer S . Costs and consequences of acute kidney injury after cardiac surgery: A cohort study. J Thorac Cardiovasc Surg. 2020; 162(3):880-887. DOI: 10.1016/j.jtcvs.2020.01.101. View

Wente M, Veit J, Bassi C, Dervenis C, Fingerhut A, Gouma D . Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007; 142(1):20-5. DOI: 10.1016/j.surg.2007.02.001. View

10.

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

11.

Long T, Helgason D, Helgadottir S, Palsson R, Gudbjartsson T, Sigurdsson G . Acute Kidney Injury After Abdominal Surgery: Incidence, Risk Factors, and Outcome. Anesth Analg. 2016; 122(6):1912-20. DOI: 10.1213/ANE.0000000000001323. View

12.

Chen J, Chang C, Wu V, Chang S, Hung K, Chu P . Long-Term Outcomes of Acute Kidney Injury After Different Types of Cardiac Surgeries: A Population-Based Study. J Am Heart Assoc. 2021; 10(9):e019718. PMC: 8200754. DOI: 10.1161/JAHA.120.019718. View

13.

Wang Y, Bellomo R . Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment. Nat Rev Nephrol. 2017; 13(11):697-711. DOI: 10.1038/nrneph.2017.119. View

14.

OConnor M, Kirwan C, Pearse R, Prowle J . Incidence and associations of acute kidney injury after major abdominal surgery. Intensive Care Med. 2015; 42(4):521-530. DOI: 10.1007/s00134-015-4157-7. View

15.

Squires 3rd M, Mehta V, Fisher S, Lad N, Kooby D, Sarmiento J . Effect of preoperative renal insufficiency on postoperative outcomes after pancreatic resection: a single institution experience of 1,061 consecutive patients. J Am Coll Surg. 2013; 218(1):92-101. PMC: 6002849. DOI: 10.1016/j.jamcollsurg.2013.09.012. View

16.

Gameiro J, Agapito Fonseca J, Neves M, Jorge S, Antonio Lopes J . Acute kidney injury in major abdominal surgery: incidence, risk factors, pathogenesis and outcomes. Ann Intensive Care. 2018; 8(1):22. PMC: 5807256. DOI: 10.1186/s13613-018-0369-7. View

17.

Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M . The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017; 161(3):584-591. DOI: 10.1016/j.surg.2016.11.014. View

18.

Brown J, Hisey W, Marshall E, Likosky D, Nichols E, Everett A . Acute Kidney Injury Severity and Long-Term Readmission and Mortality After Cardiac Surgery. Ann Thorac Surg. 2016; 102(5):1482-1489. PMC: 5077656. DOI: 10.1016/j.athoracsur.2016.04.020. View

19.

Shia B, Qin L, Lin K, Fang C, Tsai L, Kao Y . Age comorbidity scores as risk factors for 90-day mortality in patients with a pancreatic head adenocarcinoma receiving a pancreaticoduodenectomy: A National Population-Based Study. Cancer Med. 2019; 9(2):562-574. PMC: 6970054. DOI: 10.1002/cam4.2730. View

20.

Jagarlamudi N, Wong F . Acute kidney injury: prediction, prognostication and optimisation for liver transplant. Hepatol Int. 2020; 14(2):167-179. DOI: 10.1007/s12072-020-10018-0. View