The following is a summary of “Systemic inflammation and acute kidney injury after colorectal surgery,” published in the March 2024 issue of Nephrology by Mannion et al.
Researchers conducted a retrospective study to assess the importance of systemic inflammation compared to other precipitating factors, such as acute kidney injury (AKI), in the 1,224 successive patients undergoing colorectal surgery. This study would provide the basic data for studying the role of intensively controlling postoperative inflammation on the incidence of AKI.
They examined the patients with Kidney Disease and Improving Global Outcomes (KDIGO) criteria for AKI were used to identify the cases. The study dealt with the whole population: sepsis patients with or without sepsis (mixed group) and a smaller group of patients without sepsis (aseptic group). The key analytes to be studied were procedure duration and the first three days’ white blood cell count (POD #1 WBC) in the case of an “open” procedure and the neutrophil-to-lymphocyte ratio (POD #1 NLR) in the case of a “closed” procedure. The study used multivariable logistic regression analysis indicating a p-value of (P< 0.05) with predictors as significant. Only the latter part of the study was independent in predicting AK.
The result showed that in the mixed population, there was a significant relation between inflammation (POD #1 WBC) and AKI (P=0.0001) through the univariate regression analysis. Medications with anti-inflammatory properties, like ketorolac (P=0.047) and steroids (P=0.038), were found to reduce the incidence of AKI. In an aseptic population, inflammation (POD #1 NLR) was significantly linked to AKI (P=0.000). The multivariable analysis for both mixed and aseptic populations revealed that POD #1 WBC and POD #1 NLR were independently associated with AKI (P=0.000, P=0.022), along with procedure duration (P<0.0001, P<0.0001). The inflammation-related parameters were the most significant contribution to AKI, and it correlated with various complications that included postoperative infections (P = 0.016), chronic renal insufficiency (CRI, P<0.0001), non-infectious complications (P=0.010), 30-day readmissions (P=0.001), and length of stay (LOS, P<0.0001). Inflammation, regardless of sepsis presence, was similarly predictive of complications; postoperative infections (P=0.002, P=0.008), in-hospital complications (P=0.000, P = 0.002), 30-day readmissions (P=0.012, P=0.371), and LOS (P<0.0001, P=0.006).
Investigators concluded that the reduction of acute inflammation in the early stage post-surgery may decrease the chances of AKI as well as improvements in the condition of patients.
Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03526-w