Abstract:

Objective To explore risk factors of acute kidney injury (AKI) after surgical treatment in adult spinal tuberculosis patients whose preoperative renal function were normal.Methods A retrospective study was conducted in spinal tuberculosis patients undergoing debridement surgery (posterior debridement and interbody fusion with internal fixation) in Beijing Chest Hospital Attached to Capital Medical University from 2009 to 2018, all the patients aged ≥18 years and their preoperative renal function were normal. According to exclusion criteria, 2068 of 2535 spinal tuberculosis patients were enrolled. Based on the inclusion criteria and guidelines of kidney disease improving global outcomes (KDIGO), 31 cases with AKI after surgery were selected as AKI group, and 62 cases with the same surgical treatment were control group. Data including age, gender, body mass index (BMI), preoperative hypertension, diabetes, heart disease, smoking history, chronic obstructive pulmonary disease (COPD), anti-tuberculosis drug treatment time, serum creatinine (Scr), blood urea nitrogen (BUN), hemoglobin (Hb), uric acid, albumin, C-reactive protein (CRP), estimated glomerular filtration rate (eGFR), ASA classification, anesthesia, hypertension, hypotension, surgical duration, intraoperative medication, Hydroxyethyl starch 130/0.4 sodium chloride injection, fluid volume, blood transfusion, blood loss, urine, postoperative pulmonary infection, postoperative hospital stay, number of deaths in the hospital, were analyzed using multivariate logistic regression, in order to explore the relationship of them and postoperative AKI.Results Univariate analysis showed that the preoperative age ≥60 years old (64.52% (20/31) vs. 41.94% (26/62), χ ²=4.216, P=0.040), BMI >25 (58.06% (18/31) vs. 30.65% (19/62), χ ²=6.486, P=0.011), history of hypertension (54.84% (17/31) vs. 29.03% (18/62), χ ²=5.864, P=0.015), hyperuricemia (87.10% (27/31) vs. 67.74% (42/62), χ ²=4.043, P=0.044), anemia (54.84% (17/31) vs. 19.35% (12/62), χ ²=12.126, P=0.001), and intraoperative blood loss ≥600 ml (64.52% (20/31) vs. 35.48% (12/62), χ ²=7.034, P=0.008) were in AKI group significantly higher than those in the control group;while preoperative eGFR ≥90 ml·min ^-1·(1.73m ²) ^-1 (67.74% (21/31) vs. 87.10% (54/62), χ ²=4.960, P=0.026) and intraoperative dexmedetomidine (41.94% (13/31) vs. 64.52% (40/62), χ ²=4.299, P=0.038) were significantly lower than those in the control group. According to multivariate logistic regression analysis, BMI >25 (Wald χ ²=4.916,P=0.027,OR(95%CI):4.391 (1.182-16.238)), hyperuricemia (Wald χ ²=4.412,P=0.036,OR(95%CI):5.896 (1.126-30.874)), eGFR≥90 ml·min ^-1·(1.73m ²) ^-1 (Wald χ ²=4.283,P=0.039,OR(95%CI):0.213 (0.049-0.921)), and anemia (Wald χ ²=9.396,P=0.002,OR(95%CI):8.173 (2.133-31.314)) before surgery were risk factors for postoperative AKI. Conclusion For postoperative AKI in the spinal tuberculosis patients with normal preoperative renal function, BMI >25 and preoperative hyperuricemia and anemia are risk factors; while preoperative high eGFR are protective factors.

Key words: Tuberculosis,spinal, Surgical procedures,operative, Postoperative complications, Acute kidney injury, Factor analysis,statistical