Transfusion Thresholds and Risk Factors of Acute Kidney Injury in Gastrointestinal Oncology Surgery: Insights from a Retrospective Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Diagnostic Criteria
2.3. Inclusion and Exclusion Criteria
2.4. Surgical Procedure and Perioperative Management
2.5. Data Collection
2.6. Statistical Analysis
3. Results
3.1. Baseline Clinicopathological Characteristics
3.2. Short-Term Outcomes
3.3. Risk Factors for Postoperative AKI
3.4. Dose–Effect Relationship Between Intraoperative RBC Transfusion
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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AKI (n = 39) | Non-AKI (n = 726) | p | |
---|---|---|---|
Sex (Male, %) | 26 (66.7%) | 457 (62.9%) | 0.639 |
Age (years) | 75.2 ± 11.8 | 64.8 ± 11.8 | <0.001 |
Height (cm) | 162.7 ± 9.4 | 164.1 ± 7.7 | 0.511 |
Weight (kg) | 67.8 ± 15.5 | 63.7 ± 10.7 | 0.114 |
Weight loss (kg) | 0.8 ± 1.8 | 1.1 ± 2.9 | 0.459 |
Comorbidity (%) | 29 (74.4%) | 394 (54.3%) | 0.014 |
Diabetes (%) | 9 (23.1%) | 117 (16.1%) | 0.254 |
Hypertension (%) | 19 (48.7%) | 271 (37.3%) | 0.153 |
Cerebrovascular (%) | 8 (20.5%) | 56 (7.7%) | 0.012 |
Cardiovascular (%) | 9 (23.1%) | 78 (10.7%) | 0.033 |
Smoking (%) | 3 (7.7%) | 94 (13.0%) | 0.461 |
Alcohol use (%) | 1 (2.6%) | 62 (8.6%) | 0.242 |
Site | |||
Gastric/colon/rectum | 8/18/13 | 238/254/234 | 0.218 |
Preoperative laboratory tests | |||
WBC (×109/L) | 7.0 ± 2.2 | 6.4 ± 2.3 | 0.110 * |
Hb (g/L) | 109.9 ± 23.0 | 119.9 ± 21.5 | 0.003 * |
Alb (g/L) | 37.0 ± 3.8 | 39.5 ± 4.4 | <0.001 * |
Alt (U/L) | 14.5 ± 7.4 | 19.0 ± 16.9 | 0.055 * |
BUN (mmol/L) | 6.7 ± 3.4 | 5.4 ± 2.1 | 0.021 * |
SCr (μmol/L) | 95.7 ± 45.0 | 68.8 ± 20.7 | <0.001 * |
Glu (mmol/L) | 6.2 ± 2.2 | 5.6 ± 1.6 | 0.250 * |
Minimal invasive surgery (%) | 18 (46.2%) | 432 (59.5%) | 0.113 |
Intraoperative RBC transfusion (mL) | 374.4 ± 472.8 | 180.7 ± 375.0 | 0.001 * |
Intraoperative colloid (mL) | 243.6 ± 378.2 | 247.9 ± 307.1 | 0.654 * |
Postoperative RBC transfusion (mL) | 1394.9 ± 2293.6 | 136.0 ± 460.2 | <0.001 * |
Postoperative colloid (mL) | 65.8 ± 171.3 | 32.4 ± 180.0 | 0.016 * |
Albumin intravenous infusion (mL) | 236.6 ± 373.7 | 51.9 ± 90.0 | <0.001 * |
PCA (%) | 17 (43.6%) | 554 (76.4%) | <0.001 |
Diuretics (%) | 35 (89.7%) | 247 (34.0%) | <0.001 |
Vasopressor (%) | 35 (89.7%) | 504 (69.4%) | 0.007 |
Aminoglycoside antibiotics (%) | 7 (17.9%) | 182 (25.1%) | 0.315 |
Non-selective COX-2 inhibitors (%) | 36 (92.3%) | 657 (90.5%) | 0.706 |
Selective COX-2 inhibitors (%) | 10 (25.6%) | 133 (18.3%) | 0.253 |
AKI (n = 39) | Non-AKI (n = 726) | p | |
---|---|---|---|
Postoperative LOS (d) | 25.4 ± 22.5 | 12.3 ± 7.9 | <0.001 |
First oral feeding (d) | 8.8 ± 12.4 | 5.3 ± 4.4 | 0.255 |
ICU stay (d) | 21 (53.8%) | 163 (22.5%) | <0.001 |
Length of ICU stay (d) | 10.5 ± 11.2 | 4.3 ± 3.9 | 0.002 |
Ventilator (%) | 18 (46.2%) | 49 (6.7%) | <0.001 |
RRT (%) | 2 (5.1%) | 1 (0.1%) | 0.007 |
Complications (%) | 19 (48.3%) | 103 (14.2%) | <0.001 |
Infection (%) | 10 (25.6%) | 59 (8.1%) | <0.001 |
Leakage (%) | 3 (7.7%) | 16 (2.2%) | 0.067 |
Obstruction (%) | 1 (2.6%) | 13 (1.8%) | 0.522 |
Hemorrhage (%) | 5 (12.8%) | 17 (2.3%) | 0.004 |
30 d re-admission (%) | 5 (13.9%) | 16 (2.4%) | 0.003 |
Univariate | Multivariate | |||||
---|---|---|---|---|---|---|
OR | 95% CI | p | OR | 95% CI | p | |
Sex | ||||||
Female | Ref | |||||
Male | 1.177 | 0.595–2.330 | 0.639 | |||
Age (per 10 years) | 2.501 | 1.767–3.540 | <0.001 | 1.567 | 1.103–2.423 | 0.043 |
Weight loss | 0.940 | 0.800–1.106 | 0.458 | |||
Comorbidity | ||||||
Diabetes | 1.562 | 0.722–3.375 | 0.257 | |||
Hypertension | 1.595 | 0.836–3.042 | 0.156 | |||
Cerebrovascular | 3.088 | 1.355–7.036 | 0.007 | |||
Cardiovascular | 2.492 | 1.141–5.443 | 0.022 | |||
Site | ||||||
Gastric | Ref | |||||
Colon | 2.108 | 0.900–4.939 | 0.086 | |||
Rectum | 1.653 | 0.673–4.061 | 0.273 | |||
Minimal invasive surgery | 0.531 | 0.276–1.023 | 0.059 | |||
Intraoperative RBC transfusion (per 1000 mL) | 2.331 | 1.296–4.195 | 0.005 | 1.992 | 1.311–3.027 | 0.001 |
Intraoperative colloid (per 1000 mL) | 2.176 | 0.919–5.149 | 0.077 | |||
Postoperative RBC transfusion (per 1000 mL) | 2.938 | 2.088–4.134 | <0.001 | |||
Postoperative colloid (per 1000 mL) | 1.561 | 1.249–1.949 | <0.001 | |||
Albumin intravenous infusion (per 100 g) | 1.781 | 1.457–2.178 | <0.001 | |||
PCA | 0.239 | 0.124–0.460 | <0.001 | 0.388 | 0.163–0.928 | 0.033 |
Diuretics | 16.969 | 5.963–48.287 | <0.001 | 5.495 | 1.720–17.557 | 0.004 |
Vasopressor | 3.854 | 1.354–10.975 | 0.012 | |||
Aminoglycoside antibiotics | 0.654 | 0.284–1.507 | 0.319 | |||
Non-selective COX-2 inhibitors | 1.260 | 0.378–4.199 | 0.706 | |||
Selective COX-2 inhibitors | 1.537 | 0.731–3.232 | 0.256 | |||
Complications | ||||||
Infection | 3.898 | 1.811–8.390 | 0.001 | |||
Leakage | 3.698 | 1.030–13.270 | 0.045 | |||
Obstruction | 1.443 | 0.184–11.324 | 0.727 | |||
Hemorrhage | 6.133 | 2.136–17.611 | 0.001 | |||
Preoperative laboratory tests | ||||||
WBC (per 10 × 109/L) | 2.363 | 0.686–8.146 | 0.173 | |||
Hb (per 10 g/L) | 0.809 | 0.697–0.940 | 0.006 | |||
Alb (per 10 g/L) | 0.272 | 0.123–0.600 | 0.001 | |||
Alt (per 10 U/L) | 0.679 | 0.433–1.065 | 0.092 | |||
BUN (per 10 mmol/L) | 4.640 | 1.650–1.466 | <0.001 | |||
SCr (per 10 μmol/L) | 1.325 | 1.197–1.466 | <0.001 | 1.173 | 1.044–1.319 | 0.007 |
Glu (per 5 mmol/L) | 2.226 | 1.049–4.721 | 0.037 |
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Ma, S.; He, Q.; Yang, C.; Zhou, Z.; He, Y.; Yu, C.; Yao, D.; Zheng, L.; Huang, Y.; Li, Y. Transfusion Thresholds and Risk Factors of Acute Kidney Injury in Gastrointestinal Oncology Surgery: Insights from a Retrospective Study. Healthcare 2025, 13, 525. https://doi.org/10.3390/healthcare13050525
Ma S, He Q, Yang C, Zhou Z, He Y, Yu C, Yao D, Zheng L, Huang Y, Li Y. Transfusion Thresholds and Risk Factors of Acute Kidney Injury in Gastrointestinal Oncology Surgery: Insights from a Retrospective Study. Healthcare. 2025; 13(5):525. https://doi.org/10.3390/healthcare13050525
Chicago/Turabian StyleMa, Shuai, Qi He, Chengcan Yang, Zhiyuan Zhou, Yining He, Chaoran Yu, Danhua Yao, Lei Zheng, Yuhua Huang, and Yousheng Li. 2025. "Transfusion Thresholds and Risk Factors of Acute Kidney Injury in Gastrointestinal Oncology Surgery: Insights from a Retrospective Study" Healthcare 13, no. 5: 525. https://doi.org/10.3390/healthcare13050525
APA StyleMa, S., He, Q., Yang, C., Zhou, Z., He, Y., Yu, C., Yao, D., Zheng, L., Huang, Y., & Li, Y. (2025). Transfusion Thresholds and Risk Factors of Acute Kidney Injury in Gastrointestinal Oncology Surgery: Insights from a Retrospective Study. Healthcare, 13(5), 525. https://doi.org/10.3390/healthcare13050525