Potentially modifiable risk factors of acute kidney injury after emergency abdominal surgery

Emergency abdominal surgery has high rates of mortality and morbidity. However, perioperative strategies to mitigate adverse outcomes are not well established yet. Given the frequent comorbidities and pathophysiology of these patients, the incidence of acute kidney injury (AKI) could be high. Therefore, we aimed to investigate the incidence and prognosis of AKI and potentially modifiable risk factors of AKI after emergency abdominal surgery. We retrospectively reviewed consecutive patients who underwent emergency open abdominal surgery at a single tertiary care university hospital. The overall incidence of AKI was 20.3% (n = 96). Postoperative AKI is significantly associated with clinical outcomes including admission to ICU, length of hospital and ICU stay, and in-hospital mortality. Multivariable logistic regression analysis for postoperative AKI revealed that age, body-mass index and ASA classification class 3 or 4 versus 2 were significant predictors. Furthermore, intraoperative vasopressin infusion (odds ratio 4.06, 95% confidence interval [CI] 1.19–13.9), preoperative platelet count (odds ratio 0.72, 95% CI 0.57–0.90, p = 0.003) and maximal serum lactate level (and odds ratio 1.14, 95% CI 1.04–1.26, p = 0.006) were identified as potentially modifiable risk factors. Further prospective clinical trials are required to investigate whether modification of these risk factors could mitigate the risk of AKI.