Systemic inflammation and acute kidney injury after colorectal surgery

Abstract

Background

In this retrospective review, the relative importance of systemic inflammation among other causes of acute kidney injury (AKI) was investigated in 1224 consecutive colorectal surgery patients. A potential benefit from reducing excessive postoperative inflammation on AKI might then be estimated.

Methods

AKI was determined using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The entire population (mixed group), composed of patients with or without sepsis, and a subpopulation of patients without sepsis (aseptic group) were examined. Markers indicative of inflammation were procedure duration, the first postoperative white blood cell (POD # 1 WBC) for the mixed population, and the neutrophil-to-lymphocyte ratio (POD #1 NLR) for the aseptic population. Multivariable logistic regression was then performed using significant ( P < 0.05) predictors. The importance of inflammation among independent predictors of AKI and AKI-related complications was then assessed.

Results

AKI occurred in 24.6% of the total population. For the mixed population, there was a link between inflammation (POD # 1 WBC) and AKI ( P = 0.0001), on univariate regression. Medications with anti-inflammatory properties reduced AKI: ketorolac ( P = 0.047) and steroids ( P = 0.038). Similarly, in an aseptic population, inflammation (POD # 1 NLR) contributed significantly to AKI ( P = 0.000). On multivariable analysis for the mixed and aseptic population, the POD #1 WBC and the POD #1 NLR were independently associated with AKI ( P = 0.000, P = 0.022), as was procedure duration ( P < 0.0001, P < 0.0001). Inflammation-related parameters were the most significant contributors to AKI. AKI correlated with complications: 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, in patients with or without sepsis, was similarly a predictor 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), respectively.

Conclusions

Systemic inflammation is an important cause of AKI. Limiting early postsurgical inflammation has the potential to improve postoperative outcomes.