BACKGROUND Acute kidney injury (AKI) is a common complication following non-cardiac surgery with adverse short- and long- term morbidity and mortality. Evidence shows that hypoalbuminemia is associated with increased AKI risk in patients with infectious diseases and cancer and following cardiac surgery and transplant surgery. However, little evidence is available on non-cardiac surgery population. Thus, we investigated the association between preoperative hypoalbuminemia and AKI following non-cardiac surgery. METHODS We retrospectively assessed perioperative risk factors and preoperative serum albumin concentration in 729 consecutive adult patients who underwent non-cardiac surgery from July 1, 2017, to June 30, 2018. Each patient was categorized according to maximal Kidney Disease Improving Global Outcomes criteria based on creatinine changes and urine output within the first week after surgery. Multivariate Logistic regression models were used to analyze the association between preoperative hypoalbuminemia and postoperative AKI. RESULTS Of 729 patients, 188 (25.8%) developed AKI. AKI incidence was higher in patients with preoperative serum albumin < 37.5 g/L than in those with preoperative serum albumin ≥37.5 g/L [35.9% (98/273) vs. 19.7% (90/456), P < 0.001]. Multivariate logistic regression analysis showed that preoperative serum albumin < 37.5 g/L (odds ratio 1.892; 95% confidence interval 1.238-2.891; P = 0.003) was independently associated with postoperative AKI. Patients with preoperative serum albumin < 37.5 g/L tended to have a higher but not significant ratio in AKI stage 2 (2.6% vs 1.1%, P = 0.144) and much higher ratio in AKI stage 3 (4.8% vs 0.7%, P < 0.001) than those with preoperative serum albumin ≥37.5 g/L. AKI patients had a higher in-hospital mortality rate [6.9% (13/188) vs. 0.2% (1/541), P < 0.001]. Kaplan-Meier analysis revealed that the cumulative survival rate decreased with increasing AKI severity (P < 0.001). Postoperative AKI was also associated with other worse outcomes, such as prolonged mechanical ventilation [53.4 (33.0, 73.8) vs 14.7 (11.1, 18.3) hours, P < 0.001], intensive care unit stay [4.0 (3.1, 4.9) vs 2.0 (1.8, 2.3) days, P < 0.001], postoperative hospital stay [17.8 (14.8, 20.9) vs 12.3 (11.3, 13.3) days, P < 0.001], and higher total cost [13,453 (8538, 20,228) vs 11,306 (6277, 16,400) dollars, P < 0.001]. CONCLUSIONS Preoperative hypoalbuminemia was independently associated with AKI after non-cardiac surgery, and postoperative AKI was associated with poor outcomes.

中文翻译：

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非心脏手术后高危患者的术前低白蛋白血症与急性肾损伤相关：一项回顾性队列研究。

背景技术急性肾脏损伤（AKI）是非心脏手术后的常见并发症，短期和长期的发病率和死亡率均很差。有证据表明，患有感染性疾病和癌症的患者以及心脏手术和移植手术后，低白蛋白血症与AKI风险增加有关。但是，关于非心脏外科手术人群的证据很少。因此，我们调查了非心脏手术后术前低白蛋白血症与AKI之间的关系。方法我们回顾性评估了2017年7月1日至2018年6月30日接受连续性非心脏手术的729名成年患者的围手术期危险因素和术前血清白蛋白浓度。根据患者在手术后第一周内肌酐的变化和尿量的变化，根据最大的肾脏疾病改善总体结果标准对每个患者进行分类。多元Logistic回归模型用于分析术前低白蛋白血症与术后AKI之间的关系。结果在729例患者中，有188例（25.8％）发生了AKI。术前血清白蛋白<37.5 g / L的患者的AKI发生率高于术前血清白蛋白≥37.5 g / L的患者[35.9％（98/273）对19.7％（90/456），P <0.001]。多元logistic回归分析显示，术前血清白蛋白<37.5 g / L（几率1.892； 95％置信区间1.238-2.891； P = 0.003）与术后AKI独立相关。术前血清白蛋白<37。5 g / L的AKI第2阶段的比率往往较高但不显着（2.6％vs 1.1％，P = 0.144），而AKI第3阶段的比率要高得多（4.8％vs 0.7％，P <0.001）。术前血清白蛋白≥37.5g / L。AKI患者的院内死亡率较高[6.9％（13/188）对0.2％（1/541），P <0.001]。Kaplan-Meier分析显示，累积生存率随AKI严重程度的增加而降低（P <0.001）。术后AKI还与其他较差的预后相关，例如延长的机械通气时间[53.4（33.0，73.8）vs 14.7（11.1，18.3）小时，P <0.001]，重症监护病房住院时间[4.0（3.1，4.9）vs 2.0（ 1.8，2.3）天，P <0.001]，术后住院时间[17.8（14.8，20.9）vs 12.3（11.3，13.3）天，P <0.001]，总费用更高[13,453（8538，20,228）vs 11,306（6277） ，16,400）美元，P < 0.001]。结论非心脏手术后，术前低白蛋白血症与AKI独立相关，而术后AKI与不良预后相关。