Intraoperative hyperthermia is associated with increased acute kidney injury following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a retrospective cohort study

Acute kidney injury (AKI) is common after cytoreduction surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for peritoneal surface malignancies. Herein we analyzed the association between intraoperative hyperthermia and AKI following CRS-HIPEC. In this retrospective cohort study, we collected baseline and perioperative data from patients who underwent CRS-HIPEC mainly for pseudomyxoma peritonei between 2014 and 2020. Nasopharyngeal temperature was recorded at 5-min intervals. The area above the threshold was calculated for intraoperative hyperthermia (&gt;37.0 °C). AKI was diagnosed and classified according to the KDIGO creatinine criteria. A multivariable logistic regression model was established to assess the association between hyperthermia and AKI. A total of 480 patients were included in the analysis. Of these, 10.6% (51/480) developed AKI within 7 postoperative days. After correction for confounding factors, a larger area above the threshold of hyperthermia was significantly associated with an increased risk of AKI (odds ratio [OR] 1.36, 95% CI 1.14–1.63, <i>p</i> = 0.001). Among other factors, older age (OR 1.05, 95% CI 1.02–1.09, <i>p</i> = 0.002), postoperative hypotension requiring vasopressors (OR 2.09, 95% CI 1.02–4.27, <i>p</i> = 0.042), and intraperitoneal chemotherapy containing cisplatin (OR 2.75, 95% CI 1.20–6.33, <i>p</i> = 0.017) were also associated with an increased risk of AKI. Patients with AKI required longer mechanical ventilation, stayed longer in the intensive care unit and hospital, developed more complications, and required more intensive care unit readmission. Among patients undergoing CRS-HIPEC, intraoperative hyperthermia was independently associated with a higher risk of AKI; this effect was additive to other risk factors including cisplatin-containing chemotherapy.

急性肾损伤（Acute kidney injury, AKI）在针对腹膜表面恶性肿瘤的细胞减灭术联合腹腔热灌注化疗（cytoreduction surgery and hyperthermic intraperitoneal chemotherapy, CRS-HIPEC）术后较为常见。本研究旨在分析CRS-HIPEC术中热疗与术后AKI的关联。本回顾性队列研究纳入了2014至2020年间主要因腹膜假黏液瘤接受CRS-HIPEC治疗的患者，收集其基线及围手术期相关数据。以5分钟为间隔记录患者鼻咽温度，计算术中热疗（体温＞37.0℃）的阈值以上累积面积。依据KDIGO肌酐标准诊断并分级AKI，构建多因素logistic回归模型以评估热疗与AKI的关联。本研究共纳入480例患者进行分析，其中10.6%（51/480）的患者在术后7天内发生AKI。校正混杂因素后，术中热疗阈值以上的累积面积越大，AKI发生风险显著升高（比值比[OR]=1.36，95%置信区间[CI]：1.14~1.63，p=0.001）。其余与AKI风险升高相关的因素还包括：年龄更大（OR=1.05，95%CI：1.02~1.09，p=0.002）、术后需使用血管升压药维持的低血压（OR=2.09，95%CI：1.02~4.27，p=0.042）以及术中腹腔灌注含顺铂的化疗方案（OR=2.75，95%CI：1.20~6.33，p=0.017）。发生AKI的患者机械通气时长更长、重症监护病房（intensive care unit, ICU）及住院停留时间更久，并发症发生率更高，且需更多次ICU再次收治。本研究结果显示，在接受CRS-HIPEC的患者中，术中热疗与AKI发生风险升高独立相关，且该效应叠加于含顺铂化疗等其他AKI危险因素之上。