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
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 ri...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-04-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.5543 |
| _version_ | 1797838396203204608 |
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| author | Yuchen Ji Yiran Zhou Ziyun Shen Haoda Chen Shulin Zhao Xiaxing Deng Baiyong Shen |
| author_facet | Yuchen Ji Yiran Zhou Ziyun Shen Haoda Chen Shulin Zhao Xiaxing Deng Baiyong Shen |
| author_sort | Yuchen Ji |
| collection | DOAJ |
| description | 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 m2 (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. |
| first_indexed | 2024-04-09T15:41:09Z |
| format | Article |
| id | doaj.art-bf421c8c310b456f890ae245b60b8059 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-04-09T15:41:09Z |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-bf421c8c310b456f890ae245b60b80592023-04-27T10:12:43ZengWileyCancer Medicine2045-76342023-04-011277823783410.1002/cam4.5543Risk 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 patientsYuchen Ji0Yiran Zhou1Ziyun Shen2Haoda Chen3Shulin Zhao4Xiaxing Deng5Baiyong Shen6Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaAbstract 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 m2 (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.https://doi.org/10.1002/cam4.554330‐day mortalitylong‐term survivalpancreaticoduodenectomypostoperative acute kidney injury |
| spellingShingle | Yuchen Ji Yiran Zhou Ziyun Shen Haoda Chen Shulin Zhao Xiaxing Deng Baiyong Shen 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 Medicine 30‐day mortality long‐term survival pancreaticoduodenectomy postoperative acute kidney injury |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | 30‐day mortality long‐term survival pancreaticoduodenectomy postoperative acute kidney injury |
| url | https://doi.org/10.1002/cam4.5543 |
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