Exploring the Role of Serum Cystatin C in Early Detection of Acute Kidney Injury among On-Pump Cardiac Surgery Patients: A Single-Center Investigation in Bangladesh

Background: Acute Kidney Injury (AKI) stands as a prominent postoperative complication in on-pump cardiac surgery, with repercussions on morbidity, mortality, and hospitalization duration. Current diagnostic criteria relying on serum creatinine levels exhibit a delayed identification of AKI, prompting an exploration of alternative biomarkers. Aims and Objectives: This study is designed to overcome diagnostic constraints and explore the viability of serum Cystatin C as an early predictor of Acute Kidney Injury (AKI) in individuals undergoing on-pump cardiac surgery. The investigation aims to establish the relationship between serum Cystatin C levels and the onset of AKI in patients subjected to on-pump cardiac surgery. Primary objectives involve the assessment of the diagnostic effectiveness of serum Cystatin C, its comparison with serum creatinine, and the exploration of its potential for the early identification and treatment of AKI. Methodology: Conducted as a single-center study at the cardiac surgery department of BSMMU in Bangladesh from September 2020 to August 2022, a comparative cross-sectional analysis involved 31 participants categorized into No AKI and AKI groups based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Data collection encompassed preoperative, post-CBP (cardiopulmonary bypass) conclusion at 2 hours, postoperative day 1, and postoperative day 2 intervals. Statistical analyses included Chi-squared tests, independent Student’s t-tests, and one-sample t-tests. Significance was set at P Results: The study revealed no significant differences in baseline characteristics between the No AKI and AKI groups, except for CPB time and cross-clamp time. Serum Cystatin C levels in the AKI group exhibited statistical significance at various time points, highlighting its potential as an early detector. Conversely, Serum Creatinine levels in the AKI group showed no statistical significance. The Receiver Operating Characteristic (ROC) curve analysis further supported the efficacy of serum Cystatin C, with an Area under the ROC Curve of 0.864 and a cut-off value of 0.55 (p Conclusion: This study supports the superior utility of serum Cystatin C as an early detector of AKI in on-pump cardiac surgery patients compared to serum creatinine. Its ability to identify AKI several hours earlier may contribute to reduced morbidity, mortality, and healthcare costs. The findings underscore the significance of exploring novel biomarkers for improved post-cardiac surgery renal function assessment.

Application of multidisciplinary team-based integrated traditional Chinese medicine and Western medicine in rotator cuff injury patients undergoing arthroscopic surgery

BACKGROUND Arthroscopic rotator cuff repair is a common surgical treatment for rotator cuff injuries(RCIs).Although this procedure has certain clinical advantages,it requires rehabilitation management interventions to ensure therapeutic efficacy.AIM To investigate the effect of integrated traditional Chinese medicine and Western medicine(TCM-WM)under the multidisciplinary team(MDT)model on the postoperative recovery of patients undergoing arthroscopic surgery for RCIs.METHODS This study enrolled 100 patients who underwent arthroscopic rotator cuff repair for RCIs at the Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine between June 2021 and May 2024.They were divided into a control group(n=48)that received routine rehabilitation treatment and an experimental group(n=52)that received TCM-WM under the MDT model(e.g.,acupuncture,TCM traumatology and orthopedics,and rehabilitation).The results of the Constant–Murley Shoulder Score(CMS),Visual Analogue Scale(VAS),Shoulder Pain and Disability Index(SPADI),muscular strength evaluation,and shoulder range of motion(ROM)assessments were analyzed.RESULTS After treatment,the experimental group showed significantly higher CMS scores in terms of pain,functional activity,shoulder joint mobility,and muscular strength than the baseline and those of the control group.The experimental group also exhibited significantly lower VAS and SPADI scores than the baseline and those of the control group.In addition,the experimental group showed significantly enhanced muscular strength(forward flexor and external and internal rotator muscles)and shoulder ROM(forward flexion,abduction,and lateral abduction)after treatment compared with the control group.CONCLUSION TCM-WM under the MDT model improved shoulder joint function,relieved postoperative pain,promoted postoperative functional recovery,and facilitated the recovery of muscular strength and shoulder ROM in patients with RCIs who underwent arthroscopic rotator cuff repair.

Preoperative Serum Albumin Levels and Postoperative Acute Kidney Injury in Off-Pump Coronary Artery Bypass Surgery: A Single-Center Study in Bangladesh

Background: Serum albumin, a vital plasma protein, helps maintain intravascular colloidal osmotic pressure, cardiac output, and renal function. Low preoperative serum albumin is linked to poor outcomes, including acute kidney injury (AKI), after off-pump coronary artery bypass (OPCAB) surgery. This study aimed to assess the relationship between preoperative serum albumin levels and early postoperative renal injury. Methods: This prospective comparative cross-sectional study was conducted from August 2019 to February 2021 at the National Heart Foundation Hospital & Research Institute, Bangladesh. It included 160 adult patients with normal preoperative renal function undergoing OPCAB. Patients were divided into two groups: Group A (serum albumin ≥ 4.0 gm/dl) and Group B (serum albumin Results: Preoperative serum albumin was significantly different between groups (Group A: 4.21 ± 0.05 gm/dl, Group B: 3.69 ± 0.04 gm/dl, p = 0.028). Group B had a higher incidence of hypertension (71.25% vs. 51.25%, p st and 3rd postoperative days were higher in Group B (p th day. Postoperative AKI occurred in 18.75% of Group A and 36.25% of Group B. Multivariate regression indicated that low preoperative serum albumin is an independent risk factor for postoperative AKI (p = 0.012, OR = 1.815, CI: 0.675 - 1.162). Conclusion: Preoperative serum albumin level is a valuable predictor of postoperative renal function. Ensuring high normal serum albumin levels before surgery can help minimize the risk of postoperative AKI.

Minimally Invasive Maxillofacial Surgery Using Digital Work Surgery: A Case of Alveolar Ridge Reconstruction after Maxillary Cystectomy

Introduction: Iliac particulate cancellous bone and marrow (PCBM) is commonly used as a high-quality reconstruction material;however, PCBM cannot be extracted in sufficient amounts to meet demand. To determine the appropriate amount of iliac PCBM to be collected, we used digital technology to measure the volume required for jaw reconstruction before surgery. Clinical Case: The patient, a 23-year-old man, underwent surgery for a calcifying odontogenic cyst. A maxillary cyst occupied the left anterior-premolar region (tooth 21 - 25) and the deciduous canine remained;a permanent canine was included in the cyst. We planned to preserve the teeth except for the impacted canine, completely excise the maxillary cyst, and preserve the alveolar ridge morphology. Preoperative digital imaging was used to determine the amount of alveolar ridge reconstruction required and accordingly determine the amount of iliac cancellous bone to be harvested. We used a titanium mesh tray and grafts of iliac particulate cancellous bone and marrow to reconstruct the alveolar ridge. The amount of iliac cancellous bone that needed to be collected was clarified and the supply amount could be collected in just the right amount;thus, the cortical bone of the iliac inner plate could be preserved. The alveolar bone morphology was reconstructed to allow the placement of dental implants as per the preoperative digital surgery. Three years after the operation, no sign of recurrence has been observed. Conclusion: Minimally invasive surgery was performed by clarifying the amount of iliac cancellous bone graft that needs to be harvested, which improved the accuracy of surgery.

Intraoperative Blood Glucose Levels and Postoperative Acute Kidney Injury in Pediatric Patients Having Congenital Heart Surgery under Cardiopulmonary Bypass

Purpose:This study sought to explore the effect of intraoperative mean blood glucose levels and variability on postoperative acute kidney injury(AKI)in children undergoing congenital cardiac surgery.Methods:We conducted a prospective nested case-control study in children(age<18 years)undergoing congenital heart surgery with cardiopulmonary bypass(CPB)at the Fuwai Hospital between April 01,2022 and July 30,2022.Cases were individuals who developed AKI within the first postoperative 7 days(AKI group)and controls were those without AKI(Non-AKI group)according to KDIGO criteria.AKI and Non-AKI groups unmatched and 1:1 matched by age,sex,and baseline serum creatinine were separately analyzed.Multivariate logistic and conditional logistic regressions were used to assess the associations between blood glucose variables and AKI.Results:688 consecutively approached patients were included in the final analysis.On multivariate analysis,intra-CPB(adjusted odds ratio[OR]0.802;95%confidence interval[CI],0.706 to 0.912;p=0.001)and post-CPB(adjusted OR 0.830;95%CI,0.744 to 0.925;p=0.001)blood glucose levels were associated with postoperative AKI.There were no significant differences in pre-CPB blood glucose(adjusted OR 0.926;95%CI,0.759 to 1.129;p=0.446)or intraoperative glycemic fluctuations(adjusted OR 0.905;95%CI,0.723 to 1.132;p=0.382)between AKI and Non-AKI groups.Results based on matched cases and controls were consistent with those from the unmatched analyses.Conclusion:Higher intraoperative blood glucose levels during and after CPB were protective factors against postoperative AKI in pediatric patients after congenital heart surgery.

Incidence and peri-operative risk factors for development of acute kidney injury in patients after cardiac surgery:A prospective observational study

BACKGROUND Patients admitted to intensive care unit(ICU) after cardiac surgery develop acute kidney injury(AKI) immediately post-operation. We hypothesized that AKI occurs mainly due to perioperative risk factors and may affect outcome.AIM To assess peri-operative risk factors for AKI post cardiac surgery and its relationship with clinical outcome.METHODS This was an observational single center, tertiary care setting study, which enrolled 206 consecutive patients, admitted to ICU after cardiac surgery. Patients were followed-up until ICU discharge or death, in order to determine the incidence of AKI, perioperative risk factors for AKI and its association with outcome.Univariate and multivariate logistic regression analysis was performed to assess predictor variables for AKI development.RESULTS After ICU admission, 55 patients(26.7%) developed AKI within 48 h. From the logistic regression analysis performed, high EuroScore Ⅱ(OR: 1.18;95%CI: 1.06-1.31, P = 0.003), white blood cells(WBC) pre-operatively(OR: 1.0;95%CI: 1.0-1.0, P = 0.002) and history of chronic kidney disease(OR: 2.82;95%CI: 1.195-6.65, P = 0.018) emerged as independent predictors of AKI among univariate predictors. AKI that developed AKI had longer duration of mechanical ventilation [1113(777–2195) vs 714(511–1020) min, P = 0.0001] and ICU length of stay [70(28–129) vs 26(21–51) h, P = 0.0001], higher rate of ICU-acquired weakness(16.4% vs 5.3%, P =0.015), reintubation(10.9% vs 1.3%, P = 0.005), dialysis(7% vs 0%, P = 0.005), delirium(36.4% vs 23.8%, P = 0.001) and mortality(3.6% vs 0.7%, P = 0.046).CONCLUSION Patients present frequently with AKI after cardiac surgery. EuroScore Ⅱ, WBC count and chronic kidney disease are independent predictors of AKI development. The occurrence of AKI is associated with poor outcome.

Resection and reconstruction in high-grade pancreatic head injuries

This study by Chui et al adds further important evidence in the treatment of highgrade pancreatic injuries and endorses the concept of the model of pancreatic trauma care designed to optimize treatment,minimize morbidity and enhance survival in patients with complex pancreatic injuries.Although the authors have demonstrated favorable outcomes based on their limited experience of 5 patients who underwent a pancreaticoduodenectomy(PD),including 2 patients who were“unstable”and did not have damage control surgery(DCS),we would caution against the general recommendations promoting index PD without DCS in“unstable”grade 5 pancreatic head injuries.

Needle arthroscopic-assisted repair of tibio-fibular syndesmosis acute injury:A case report

BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report explores the use of needle arthroscopy as a minimally invasive technique for the repair of tibiofibular syndesmosis injuries.CASE SUMMARY We report on a 40-year-old male patient who presented with a trimalleolar fracture and ankle subluxation following a high ankle sprain.Due to significant swelling and poor soft tissue quality,initial management involved external stabilization.Subsequently,needle arthroscopy was employed to assess and treat the tibiofibular syndesmosis injury.The procedure,performed under spinal anesthesia and fluoroscopic control,included nanoscopic evaluation of the ankle joint and reduction of the syndesmosis using a suture button.Follow-up assessments showed significant improvement in pain levels,range of motion,and functional scores.At 26 weeks post-procedure,the patient achieved full range of motion and pain-free status.Needle arthroscopy offers a promising alternative for the management of acute tibiofibular syndesmosis injuries,combining diagnostic and therapeutic capabilities with minimal invasiveness.CONCLUSION This technique may enhance clinical outcomes and reduce recovery times,warranting further investigation and integration into clinical practice.

Digital surgery for gastroenterological diseases

Advances in machine learning,computer vision and artificial intelligence methods,in combination with those in processing and cloud computing capability,portend the advent of true decision support during interventions in real-time and soon perhaps in automated surgical steps.Such capability,deployed alongside technology intraoperatively,is termed digital surgery and can be delivered without the need for high-end capital robotic investment.An area close to clinical usefulness right now harnesses advances in near infrared endolaparoscopy and fluorescence guidance for tissue characterisation through the use of biophysics-inspired algorithms.This represents a potential synergistic methodology for the deep learning methods currently advancing in ophthalmology,radiology,and recently gastroenterology via colonoscopy.As databanks of more general surgical videos are created,greater analytic insights can be derived across the operative spectrum of gastroenterological disease and operations(including instrumentation and operative step sequencing and recognition,followed over time by surgeon and instrument performance assessment)and linked to value-based outcomes.However,issues of legality,ethics and even morality need consideration,as do the limiting effects of monopolies,cartels and isolated data silos.Furthermore,the role of the surgeon,surgical societies and healthcare institutions in this evolving field needs active deliberation,as the default risks relegation to bystander or passive recipient.This editorial provides insight into this accelerating field by illuminating the nearfuture and next decade evolutionary steps towards widespread clinical integration for patient and societal benefit.

Telemedicine and digital management in repair and regeneration after nerve injury and in nervous system diseases

To the editor, We read with interest the article, ＂Facilitating transparency in spinal cord injury studies using data standards and ontol- ogles＂ by Professor Vance E Lemmon, University of Miami, USA （Lemmon et al., 2014） and would like to add to the discussion on digital management in spinal cord injury. We have analyzed the advancements in the treatment of spinal cord injury, traumatic brain jury. Encouraging outcomes injury and peripheral nerve in- have been achieved in the area of regulating axon growth in vivo and in vitro. However, such a large amount of information neither provides in-depth insight for other scholars nor provides detailed therapeutic nrotocols for clinical studies.

Establishment of a new method of digital orthopedic surgery and its widespread clinical application

Objective To create an unique new method of digital orthopedic surgery and widely apply to spinal surgery,treatment of bone and joint injuries,ligament reconstruction and repair,bone minor resection and reconstruction,serious bone and

Current and future surgery strategies for spinal cord injuries

Spinal cord trauma is a prominent cause of mortality and morbidity. In developed countries a spinal cord injury(SCI) occurs every 16 min. SCI occurs due to tissue destruction, primarily by mechanical and secondarily ischemic. Primary damage occurs at the time of the injury. It cannot be improved. Following the primary injury, secondary harm mechanisms gradually result in neuronal death. One of the prominent causesof secondary harm is energy deficit, emerging from ischemia, whose main cause in the early stage, is impaired perfusion. Due to the advanced techniques in spinal surgery, SCI is still challenging for surgeons. Spinal cord doesn't have a self-repair property. The main damage occurs at the time of the injury primarily by mechanical factors that cannot be improved. Secondarily mechanisms take part in the following sections. Spinal compression and neurological deficit are two major factors used to decide on surgery. According to advanced imaging techniques the classifications systems for spinal injury has been changed in time. Aim of the surgery is to decompress the spinal channel and to restore the spinal alinement and mobilize the patient as soon as possible. Use of neuroprotective agents as well as methods to achieve cell regeneration in addition to surgery would contribute to the solution.

Iatrogenic bile duct injuries from biliary tract surgery

BACKGROUND:Cholecystectomy is the most commonly performed procedure in general surgery.However,bile duct injury is a rare but still one of the most common complications.These injuries sometimes present variably after primary surgery.Timely detection and appropriate management decrease the morbidity and mortality of the operation. METHODS:Five cases of iatrogenic bile duct injury(IBDI) were managed at the Department of Surgery,First Affiliated Hospital,Xi’an Jiaotong University.All the cases who underwent both open and laparoscopic cholecystectomy had persistent injury to the biliary tract and were treated accordingly. RESULTS:Recovery of the patients was uneventful.All patients were followed-up at the surgical outpatient department for six months to three years.So far the patients have shown good recovery. CONCLUSIONS:In cases of IBDI it is necessary to perform the operation under the supervision of an experienced surgeon who is specialized in the repair of bile duct injuries,and it is also necessary to detect and treat the injury as soon as possible to obtain a satisfactory outcome.

Promoting axonal regeneration following nerve surgery： a perspective on ultrasound treatment for nerve injuries

Nerve injury is often associated with limited axonal regeneration and thus leads to delayed or incomplete axonal reinnervation.As a consequence of slow nerve regeneration,target muscle function is often insufficient and leads to a lifelong burden.Recently,the diagnosis of nerve injuries has been improved and likewise surgical reconstruction has undergone significant developments.However,the problem of slow nerve regeneration has not been solved.In a recent meta-analysis,we have shown that the application of low-intensity ultrasound promotes nerve regeneration experimentally and thereby can improve functional outcomes.Here we want to demonstrate the experimental effect of low intensity ultrasound on nerve regeneration,the current state of investigations and its possible future clinical applications.

Practical approaches to effective management of intestinal radiation injury:Benefit of resectional surgery

AIM:To study the outcome of patients undergoing surgical resection of the bowel for sustained radiation-induced damage intractable to conservative management.METHODS:During a 7-year period we operated on 17 cases (5 male,12 female) admitted to our surgical department with intestinal radiation injury (IRI).They were originally treated for a pelvic malignancy by surgical resection followed by postoperative radiotherapy.During follow-up,they developed radiation enteritis requiring surgical treatment due to failure of conservative management.RESULTS:IRI was located in the terminal ileum in 12 patients,in the rectum in 2 patients,in the descending colon in 2 patients,and in the cecum in one patient.All patients had resection of the affected region(s).There were no postoperative deaths,while 3 cases presented with postoperative complications (17.7%).All patients remained free of symptoms without evidence of recurrence of IRI for a median follow-up period of 42 mo (range,6-96 mo).CONCLUSION:We report a favorable outcome without IRI recurrence of 17 patients treated by resection of the diseased bowel segment.

Efficacy of digital breast tomosynthesis combined with magnetic resonance imaging in the diagnosis of early breast cancer

BACKGROUND The incidence and mortality rate of breast cancer in China rank 120th and 163rd,worldwide,respectively.The incidence of breast cancer is on the rise;the risk increases with age but is slightly reduced after menopause.Early screening,diagnosis,and timely determination of the best treatment plan can ensure clinical efficacy and prognosis.AIM To evaluate the clinical value of magnetic resonance imaging(MRI) combined with digital breast tomosynthesis(DBT) in diagnosing early breast cancer and the effect of breast-conserving surgery by arc incision.METHODS This study was divided into two parts.Firstly,110 patients with early breast cancer confirmed by pathological examination and 110 with benign breast diseases diagnosed simultaneously in Changzhi People’s Hospital of Shanxi Province and Shanxi Dayi Hospital from May 2019 to September 2020 were included in the breast cancer group and the benign group,respectively.Both groups underwent DBT and MRI examination,and the pathological results were used as the gold standard to evaluate the effectiveness of the combined application of DBT and MRI in the diagnosis of early breast cancer.Secondly,according to the operation method,110 patients with breast cancer were divided into either a breast-conserving group(69 patients) or a modified radical mastectomy group(41 patients).The surgical effect,cosmetic effect,and quality of life of the two groups were compared.RESULTS Among the 110 cases of breast cancer,66 were of invasive ductal carcinoma(60.00%),and 22 were of ductal carcinoma in situ(20.00%).Among the 110 cases of benign breast tumors,55 were of breast fibromas(50.00%),and 27 were of breast adenosis(24.55%).The sensitivity,specificity,and area under the curve(AUC) of DBT in the differential diagnosis of benign and malignant breast tumors were 73.64%,84.55%,and 0.791,respectively.The sensitivity,specificity,and AUC of MRI in the differential diagnosis of benign and malignant breast tumors were 84.55%,85.45%,and 0.850,respectively.The sensitivity,specificity,and AUC of DBT combined with MRI in the differential diagnosis of benign and malignant breast tumors were 97.27%,93.64%,and 0.955,respectively.The blood loss,operation time and hospitalization time of the breast-conserving group were significantly lower than those of the modified radical treatment group,and the difference was statistically significant(P < 0.05).After 3 mo of observation,the breast cosmetic effect of the breast-conserving group was better than that of the modified radical group,and the difference was statistically significant(P < 0.05).Before surgery,the quality-of-life scores of the breast-conserving and modified radical mastectomy groups did not differ(P > 0.05).Three months after surgery,the quality-of-life scores in both groups were higher than those before surgery(P < 0.05),and the quality-of-life score of the breast-conserving group was higher than that of the modified radical group(P < 0.05).In the observation of tumor recurrence rate two years after the operation,four patients in the breast-conserving group and one in the modified radical treatment group had a postoperative recurrence.There was no significant difference in the recurrence rate between the two groups(χ2 = 0.668,P = 0.414 > 0.05).CONCLUSION MRI combined with DBT in diagnosing early breast cancer can significantly improve the diagnostic efficacy compared with the two alone.Breast-conserving surgery leads to better cosmetic breast effects and reduces the impact of surgery on postoperative quality of life.

Machine learning approach to predict acute kidney injury after liver surgery

BACKGROUND Acute kidney injury(AKI)after surgery appears to increase the risk of death in patients with liver cancer.In recent years,machine learning algorithms have been shown to offer higher discriminative efficiency than classical statistical analysis.AIM To develop prediction models for AKI after liver cancer resection using machine learning techniques.METHODS We screened a total of 2450 patients who had undergone primary hepatocellular carcinoma resection at Changzheng Hospital,Shanghai City,China,from January 1,2015 to August 31,2020.The AKI definition used was consistent with the Kidney Disease:Improving Global Outcomes.We included in our analysis preoperative data such as demographic characteristics,laboratory findings,comorbidities,and medication,as well as perioperative data such as duration of surgery.Computerized algorithms used for model development included logistic regression(LR),support vector machine(SVM),random forest(RF),extreme gradient boosting(XGboost),and decision tree(DT).Feature importance was also ranked according to its contribution to model development.RESULTS AKI events occurred in 296 patients(12.1%)within 7 d after surgery.Among the original models based on machine learning techniques,the RF algorithm had optimal discrimination with an area under the curve value of 0.92,compared to 0.87 for XGBoost,0.90 for DT,0.90 for SVM,and 0.85 for LR.The RF algorithm also had the highest concordance-index(0.86)and the lowest Brier score(0.076).The variable that contributed the most in the RF algorithm was age,followed by cholesterol,and surgery time.CONCLUSION Machine learning algorithms are highly effective in discriminating patients at high risk of developing AKI.The successful application of machine learning models may help guide clinical decisions and help improve the long-term prognosis of patients.

Neutrophil-to-lymphocyte ratio predicts acute kidney injury occurrence after gastrointestinal and hepatobiliary surgery

BACKGROUND Postoperative acute kidney injury(AKI) is a complex pathological process involved intrarenal and systemic inflammation caused by renal hypoperfusion, nephrotoxic drugs and urinary obstruction. Neutrophil-to-lymphocyte ratio(NLR) is a marker of inflammation reflecting the progress of many diseases. However, whether NLR at admission can predict the occurrence of AKI after surgery in the intensive care unit(ICU) remains unknown.AIM To clarify the relationship between NLR and the occurrence of AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU.METHODS A retrospective analysis of 282 patients receiving surgical ICU care after gastrointestinal and hepatobiliary surgery in our hospital from December 2014 to December 2018 was performed.RESULTS Postoperative AKI occurred in 84 patients(29.79%) in this cohort. NLR by the multivariate analysis was an independent risk factor for occurrence of postoperative AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU. In this cohort, receiver operating characteristic curves of AKI occurrence showed that the optimal cut-off value of NLR was 8.380. NLR was found to be significantly correlated with the white blood cell count, neutrophil count, lymphocyte count, arterial lactate and dialysis(P < 0.05). Additionally, NLR value at admission was higher in AKI patients compared with the non-AKI patients and increased with the severity of AKI. Patients with NLR ≥ 8.380 exhibited significantly higher incidences of postoperative AKI and severe AKI than patients with NLR < 8.380(AKI: 38.12% vs 14.85%, P < 0.001;severe AKI: 14.36% vs 1.98%, P = 0.001).CONCLUSION NLR at admission is a predictor of AKI occurrence in patients with gastrointestinal and hepatobiliary surgery in ICU. NLR should be included in the routine assessment of AKI occurrence.

Two acute kidney injury risk scores for critically ill cancer patients undergoing non-cardiac surgery

BACKGROUND:Several risk scoures have been used in predicting acute kidney injury(AKI)of patients undergoing general or specific operations such as cardiac surgery.This study aimed to evaluate the use of two AKI risk scores in patients who underwent non-cardiac surgery but required intensive care.METHODS:The clinical data of patients who had been admitted to ICU during the first 24 hours of ICU stay between September 2009 and August 2010 at the Cancer Institute,Chinese Academy of Medical Sciences & Peking Union Medical College were retrospectively collected and analyzed.AKI was diagnosed based on the acute kidney injury network(AKIN) criteria.Two AKI risk scores were calculated:Kheterpal and Abelha factors.RESULTS:The incidence of AKI was 10.3%.Patients who developed AKI had a increased ICU mortality of 10.9%vs.1.0%and an in-hospital mortality of 13.0 vs.1.5%,compared with those without AKI.There was a significant difference between the classification of Kheterpal's AKI risk scores and the occurrence of AKI(P<0.001).There was no significant difference between the number of Abelha's AKI risk scores and the occurrence of AKI(P=0.499).Receiver operating characteristic curves demonstrated an area under the curve of 0.655±0.043(P=0.001,95%confidence interval:0.571-0.739) for Kheterpal's AKI risk score and 0.507±0.044(P=0.879,95%confidence interval:0.422-0.592) for Abelha's AKI risk score.CONCLUSION:Kheterpal's AKI risk scores are more accurate than Abelha's AKI risk scores in predicting the occurrence of AKI in patients undergoing non-cardiac surgery with moderate predictive capability.