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Importance of intraoperative oliguria during major abdominal surgery: findings of the Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery trial.
- Source :
-
BJA: The British Journal of Anaesthesia . Jun2019, Vol. 122 Issue 6, p726-733. 8p. - Publication Year :
- 2019
-
Abstract
- <bold>Background: </bold>The association between intraoperative oliguria during major abdominal surgery and the subsequent development of postoperative acute kidney injury (AKI) remains poorly defined. We hypothesised that, in such patients, intraoperative oliguria would be an independent predictor of subsequent AKI.<bold>Methods: </bold>We performed a post hoc analysis of data from the Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery (RELIEF) trial of conservative vs liberal fluid therapy during and after major abdominal surgery. We used χ2, logistic regression, and fractional polynomials to study the association between intraoperative oliguria defined as a urinary output <0.5 ml kg-1 h-1 and the development of postoperative AKI defined by the Kidney Disease Improving Global Outcomes consensus criteria.<bold>Results: </bold>We included 2444 of 2983 patients from the RELIEF trial in this study. A total of 889 patients (36%) met oliguric criteria intraoperatively. Oliguria occurred in 35% of those without AKI, and 44%, 48%, and 45% of those who developed postoperative AKI Stages 1-3, respectively (P<0.001 for trend). Intraoperative oliguria was associated with an increased risk of AKI, risk ratio: 1.38 (95% confidence interval: 1.14-1.44; P<0.001), but greater intensity of oliguria (urine output <0.3 ml kg-1 h-1) did not increase this risk further. Most patients with oliguria did not develop AKI; the positive predictive value of oliguria was 25.5%, and the negative predictive value was 81.6%.<bold>Conclusions: </bold>Intraoperative oliguria, defined as urine output <0.5 ml kg-1 h-1, was relatively common and was associated with postoperative AKI. However, the predictive utility of oliguria for AKI was low, whilst its absence had a good predictive value for an AKI-free postoperative course.<bold>Clinical Trial Registration: </bold>NCT01424150. [ABSTRACT FROM AUTHOR]
- Subjects :
- *FLUID therapy
*ABDOMINAL surgery
*LOGISTIC regression analysis
*KIDNEY injuries
*DATA analysis
*KIDNEY diseases
*ACUTE kidney failure prevention
*ACUTE kidney failure
*COMPARATIVE studies
*RESEARCH methodology
*INTRAOPERATIVE care
*MEDICAL cooperation
*OLIGURIA
*RESEARCH
*SURGICAL complications
*THERAPEUTICS
*EVALUATION research
*RANDOMIZED controlled trials
*PREDICTIVE tests
*DISEASE complications
TREATMENT of acute kidney failure
PREVENTION of surgical complications
Subjects
Details
- Language :
- English
- ISSN :
- 00070912
- Volume :
- 122
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- BJA: The British Journal of Anaesthesia
- Publication Type :
- Academic Journal
- Accession number :
- 136419438
- Full Text :
- https://doi.org/10.1016/j.bja.2019.01.010