Association between the preoperative N-terminal pro-B-type natriuretic peptide and acute kidney injury in gastrointestinal surgery patients managed with enhanced recovery strategy: a retrospective cohort study

Abstract

Importance Previous evidence has indicated that N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with postoperative acute kidney injury (AKI). However, the association between preoperative NT-proBNP level and postoperative AKI in surgeries managed with enhanced recovery after surgery (ERAS) strategy requires further clarification.Objective To explore the association between preoperative NT-proBNP and the incidence of postoperative AKI in patients who underwent gastrointestinal surgeries and managed with ERAS strategy.Design A retrospective cohort study.Setting A review of documented cases of elective gastrointestinal surgeries managed with ERAS strategy occurred at Xijing Hospital from 01 May 2017 to 30 June 2022.Participants A total of 629 patients aged 18 years or older who were scheduled for elective gastrointestinal surgeries and subjected to the ERAS strategy with preoperative NT-proBNP and creatinine measurements were included in the analysis.Exposure Preoperative serum concentrations of NT-proBNP.Main outcomes and measures The primary outcome was the incidence of postoperative AKI. Preoperative NT-proBNP was divided into high- or low-level groups based on the median (165 pg/ml). Logistic regression was used to explore the association between increased preoperative NT-proBNP level and risk of AKI.Results After screening 1932 case records, 629 cases were included in the final analyses. The average age was 63.5 (15.3) years old and 197 (31.3%) of them were female. Among them, 112 (17.8%) developed postoperative AKI. The incidence of AKI was 21% in the high NT-proBNP group, and 14.6% in the low NT-proBNP group. Patients with higher preoperative NT-proBNP levels (≥ 165 pg/mL) have significant higher risk of postoperative AKI as compared to those in the lower group (adjusted OR 1.75; 95% CI 1.12 to 2.73).Conclusions and relevance Increased preoperative NT-proBNP is associated with an elevated risk of postoperative AKI in patients who underwent gastrointestinal surgery and managed with ERAS strategy.Trial registry number Clinical trial registry number: NCT06145347.

Keywords: ERAS; Gastrointestinal surgery; Postoperative AKI; Preoperative NT-proBNP.

Fig. 1

Flowchart of the study

Fig. 2

The adjusted OR of AKI as a function of preoperative log (NT-proBNP) concentrations. The shadow area indicates 95% CIs. Three knots were used, located at the 5 th, 50 th, and 95 th percentiles of the log (NT-proBNP)

Fig. 3

Subgroup analysis of the trial. Abbreviations: AKI acute kidney injury, NSAIDS nonsteroidal anti-inflammatory drugs, ASA American society of Anesthesiologists, eGFR estimated glomerular filtration rate. Intraoperative fluid balance = Total volume infused-urine output-estimated blood loss − physiological requirement. Physiological requirement = body weight × 3 ml/kg/h × duration of surgery. eGFR for male = [(140 − age) × weight × 1.23]/serum creatinine, eGFR for female = [(140 − age) × weight × 1.04]/serum creatinine