학술논문
Predictive factors for nephrectomy in renal trauma; assessment of a 6-point score.
Document Type
Academic Journal
Author
Pallares-Mendez R; Department of Urology, Facultad de Medicina y Hospital Universitario 'Dr. Jose Eleuterio Gonzalez'. Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico. rigo_pallares@hotmail.com.; Cervantes-Miranda DE; Department of Urology, Facultad de Medicina y Hospital Universitario 'Dr. Jose Eleuterio Gonzalez'. Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico.; Castillo-Godinez ES; Department of Urology, Hospital Civil de Guadalajara 'Fray Antonio Alcalde', Guadalajara, Mexico.; de la Cruz-de la Cruz C; Department of Urology, Facultad de Medicina y Hospital Universitario 'Dr. Jose Eleuterio Gonzalez'. Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico.; Aguilar-Méndez MA; Department of Urology, Hospital General 'Dr. Manuel Gea González', Mexico City, Mexico.; Gutierrez-Gonzalez A; Department of Urology, Facultad de Medicina y Hospital Universitario 'Dr. Jose Eleuterio Gonzalez'. Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico.; Mendoza-Castillo F; Department of Urology, Hospital General de Zona No. 33. IMSS, Monterrey, Mexico.; Mata-Torres H; Department of Legal Surgery, Hospital Civil de Guadalajara 'Fray Antonio Alcalde', Guadalajara, Mexico.; Ochoa-Arvizo M; Department of Urology, Facultad de Medicina y Hospital Universitario 'Dr. Jose Eleuterio Gonzalez'. Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico.; Montelongo-Rodriguez F; Department of Urology, Facultad de Medicina y Hospital Universitario 'Dr. Jose Eleuterio Gonzalez'. Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico.; Hernandez-Aranda KL; Department of Urology, Facultad de Medicina y Hospital Universitario 'Dr. Jose Eleuterio Gonzalez'. Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico.; Cota-Agüero JA; Department of Urology, Facultad de Medicina y Hospital Universitario 'Dr. Jose Eleuterio Gonzalez'. Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico.
Source
Publisher: Springer Heidelberg Country of Publication: Germany NLM ID: 101313350 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1863-9941 (Electronic) Linking ISSN: 18639933 NLM ISO Abbreviation: Eur J Trauma Emerg Surg Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose: To evaluate predictive and associated risk factors for nephrectomy in renal trauma and assess a 6-point score for surgical decision-making.
Patients and Methods: This multicenter, retrospective, and observational study assessed 247 subjects with blunt or penetrating kidney trauma. Kidney injuries were classified according to the American Association for the Surgery of Trauma (AAST) Injury Scoring Scale. Renal trauma was classified as "low-grade" (Grades I-III), Grade IV, and Grade V. Subjects were compared according to conservative treatment (CTrt.) or nephrectomy. Predictive factors were evaluated with a multiple regression model. A 6-point score was evaluated with a ROC analysis.
Results: Patients requiring nephrectomy had a lower mean arterial pressure MAP compared to CTrt, 64.71 mmHg (SD ± 10.26) and 73.86 (SD ± 12.42), respectively (p = < 0.001). A response to IV solutions was observed in 90.2% of patients undergoing CTrt. (p = < 0.001, OR = 0.211, 95%CI = 0.101-0.442). Blood lactate ≥ 4 mmol/L was associated with nephrectomy (p = < 0.001). A hematoma ≥ 25 mm was observed in 41.5% of patients undergoing nephrectomy compared to 20.1% of CTrt. (p = 0.004, OR = 9.29, 95% CI = 1.37-5.58). A logistic regression analysis (p = < 0.001) showed that blood lactate ≥ 4 mmol/L (p = 0.043), an inadequate response to IV solutions (p = 0.041) and renal trauma grade IV-V (p = < 0.001), predicted nephrectomy. A 6-point score with a cut-off value ≥ 3 points showed 83% sensitivity and 87% specificity for nephrectomy with an AUC of 89.9% (p = < 0.001).
Conclusions: An inadequate response to IV solutions, a lactate level ≥ 4 mmol/L, and grade IV-V renal trauma predict nephrectomy. A score ≥ 3 points showed a good performance in this population.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Patients and Methods: This multicenter, retrospective, and observational study assessed 247 subjects with blunt or penetrating kidney trauma. Kidney injuries were classified according to the American Association for the Surgery of Trauma (AAST) Injury Scoring Scale. Renal trauma was classified as "low-grade" (Grades I-III), Grade IV, and Grade V. Subjects were compared according to conservative treatment (CTrt.) or nephrectomy. Predictive factors were evaluated with a multiple regression model. A 6-point score was evaluated with a ROC analysis.
Results: Patients requiring nephrectomy had a lower mean arterial pressure MAP compared to CTrt, 64.71 mmHg (SD ± 10.26) and 73.86 (SD ± 12.42), respectively (p = < 0.001). A response to IV solutions was observed in 90.2% of patients undergoing CTrt. (p = < 0.001, OR = 0.211, 95%CI = 0.101-0.442). Blood lactate ≥ 4 mmol/L was associated with nephrectomy (p = < 0.001). A hematoma ≥ 25 mm was observed in 41.5% of patients undergoing nephrectomy compared to 20.1% of CTrt. (p = 0.004, OR = 9.29, 95% CI = 1.37-5.58). A logistic regression analysis (p = < 0.001) showed that blood lactate ≥ 4 mmol/L (p = 0.043), an inadequate response to IV solutions (p = 0.041) and renal trauma grade IV-V (p = < 0.001), predicted nephrectomy. A 6-point score with a cut-off value ≥ 3 points showed 83% sensitivity and 87% specificity for nephrectomy with an AUC of 89.9% (p = < 0.001).
Conclusions: An inadequate response to IV solutions, a lactate level ≥ 4 mmol/L, and grade IV-V renal trauma predict nephrectomy. A score ≥ 3 points showed a good performance in this population.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)