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Abstract：
Introduction The administration of anti-cancer drugs and major abdominal surgeries have been independently identified to have a negative effect on renal function. The objectives of the study are to determine the incidence of acute kidney injury (AKI) in patients undergoing major elective abdominal surgery following chemotherapy and identify the independent predictors of postoperative AKI among such cancer patients in a tertiary care cancer institute in North India. Methods The prospective observational study included 149 patients aged 18 years or more, scheduled for elective major abdominal cancer surgery. Based on the administration of preoperative chemotherapy, the participants were divided into two study cohorts (Group 1: received preoperative chemotherapy; Group 2: did not receive preoperative chemotherapy). Patients\' preoperative characteristics, including the use of preoperative chemotherapeutic agents and intraoperative factors, were evaluated for associations with the development of AKI postoperatively using the Chi-square test and Mann-Whitney U test. Multivariable logistic regression was employed to identify the factors after adjusting for potential confounders. Results The overall incidence of postoperative AKI in major abdominal oncosurgery was 24.2% among our study participants, which was significantly higher among patients receiving preoperative chemotherapy (32.4%) as compared to those who did not receive preoperative chemotherapy (16%) (p=0.019). Besides preoperative chemotherapy, the present study also noted that high levels of preoperative urinary protein-to-creatinine ratio (UPCR) and intraoperative use of vasopressors were significantly associated with an increased risk of postoperative AKI development in the final model, after adjustment for all potential confounders. A preoperative UPCR≥0.345 predicted the development of postoperative AKI with 77.8% sensitivity and 83.2% specificity. Conclusion Considering the magnitude of the problem, identification of determinants of postoperative AKI in major abdominal surgeries in cancer patients may help anesthetists and surgeons in early detection of AKI, so that prompt precautionary measures can be put in place that can potentially impact prognosis.
摘要：
引言抗癌药物和大型腹部手术的施用已被独立地鉴定为对肾功能具有负面影响。该研究的目的是确定在接受化疗后进行大型择期腹部手术的患者中急性肾损伤（AKI）的发生率，并确定在印度北部三级癌症研究所的此类癌症患者中术后AKI的独立预测因素。方法前瞻性观察性研究纳入149例18岁及以上患者,计划进行选择性重大腹部癌症手术。在术前化疗的基础上，参与者被分为2个研究组(第1组:接受术前化疗;第2组:未接受术前化疗).患者术前特征，包括术前化疗药物的使用和术中因素，使用卡方检验和Mann-WhitneyU检验评估与术后AKI发展的相关性。在调整潜在的混杂因素后，采用多变量逻辑回归来识别因素。结果在我们的研究参与者中，大腹部肿瘤外科术后AKI的总发生率为24.2％。与未接受术前化疗的患者（16％）相比，接受术前化疗的患者（32.4％）显着更高（p=0.019）。除了术前化疗,本研究还指出，高水平的术前尿蛋白-肌酐比值（UPCR）和术中使用血管升压药与最终模型中术后AKI发生的风险增加显著相关，在对所有潜在的混杂因素进行调整后。术前UPCR≥0.345可预测术后AKI的发生,敏感性为77.8%,特异性为83.2%。结论考虑到问题的严重性，确定癌症患者腹部大手术后AKI的决定因素可能有助于麻醉师和外科医生早期发现AKI，以便及时采取可能影响预后的预防措施。
