Epidemiological investigation and risk factor analysis of acute kidney injury in non-intensive care unit hospitalized patients following neurosurgery.

BACKGROUND: Acute kidney injury (AKI) after neurosurgery is non-negligible. Given brain-kidney crosstalk, postoperative AKI (PO-AKI) can trigger adverse outcomes, but evidence remains limited for neurosurgical patients in non-ICU settings. METHODS: Data from non-ICU inpatients undergoing neurosurgical procedures were collected from Xuanwu Hospital, Capital Medical University. We observed PO-AKI incidence and performed category-weighted multiple regression to identify risk factors. RESULTS: Data from 9,692 patients were analyzed, yielding a PO-AKI incidence of 3.9%. Sixteen potential risk variables were identified: male sex or age ≥50 years versus female <50 years; intraoperative/immediate postoperative vasopressor use (OR = 4.129, 95% CI: 3.324-5.129); operation duration ≥120 min (OR = 1.797, 95% CI: 1.597-2.021); contrast agent use (OR = 1.912, 95% CI: 1.674-2.184); BMI category, with BMI < 18.5 kg/m2 as reference and overweight/obesity associated with reduced PO-AKI risk; preoperative systolic blood pressure (OR = 1.006, 95% CI: 1.003-1.010); perioperative propofol (OR = 2.041, 95% CI: 1.754-2.376), mannitol (OR = 1.766, 95% CI: 1.588-1.963), proton pump inhibitors (OR = 1.668, 95% CI: 1.472-1.892), urapidil (OR = 1.620, 95% CI: 1.442-1.821), and cephalosporin (OR = 1.283, 95% CI: 1.101-1.495); and preoperative urinary protein (OR = 1.255, 95% CI: 1.154-1.366), serum urea (OR = 1.090, 95% CI: 1.058-1.123), serum creatinine (OR = 1.007, 95% CI: 1.004-1.009), alkaline phosphatase (OR = 1.005, 95% CI: 1.004-1.007), and hemoglobin (OR = 0.988, 95% CI: 0.984-0.991). Model discrimination, assessed using the area under the receiver operating characteristic curve, was 0.785. CONCLUSION: The incidence of post-neurosurgical AKI was 3.93% among non-ICU patients. Associated factors included vasopressor use, age ≥50 years, surgery duration ≥120 min, contrast agent use, higher systolic blood pressure, anemia, elevated serum creatinine and urea, proteinuria, higher alkaline phosphatase, and medications including propofol, mannitol, proton pump inhibitors, urapidil, and cephalosporin. Propofol association and lower PO-AKI risk across BMI categories versus BMI < 18.5 kg/m2 require validation.