Vasopressors are routinely used to counteract hypotension after neuraxial anesthesia in Obstetrics. The understanding of the mechanism of hypotension and the choice of vasopressor has evolved over the years to a point...Vasopressors are routinely used to counteract hypotension after neuraxial anesthesia in Obstetrics. The understanding of the mechanism of hypotension and the choice of vasopressor has evolved over the years to a point where phenylephrine has become the preferred vasopressor. Due to the absence of definitive evidence showing absolute clinical benefit of one over the other, especially in emergency and high-risk Cesarean sections, our choice of phenylephrine over the other vasopressors like mephentermine, metaraminol, and ephedrine is guided by indirect evidence on fetalacid-base status. This review article evaluates the present day evidence on the various vasopressors used in obstetric anesthesia today.展开更多
BACKGROUND:Consensus guidelines suggested that both dopamine and norepinephrine may be used,but specific doses are not recommended.The aim of this study is to determine the predictive role of vasopressors in patients ...BACKGROUND:Consensus guidelines suggested that both dopamine and norepinephrine may be used,but specific doses are not recommended.The aim of this study is to determine the predictive role of vasopressors in patients with shock in intensive care unit.METHODS:One hundred and twenty-two patients,who had received vasopressors for 1 hour or more in intensive care unit(ICU) between October 2008 and October 2011,were included.There were 85 men and 37 women,with a median age of 65 years(55-73 years).Their clinical data were retrospectively collected and analyzed.RESULTS:The median simplified acute physiological score 3(SAPS 3) was 50(42-55).Multivariate analysis showed that septic shock(P=0.018,relative risk:4.094;95%confidential interval:1.274-13.156),SAPS 3 score at ICU admission(P=0.028,relative risk:1.079;95%confidential interval:1.008-1.155),and norepinephrine administration(P<0.001,relative risk:9.353;95%confidential interval:2.667-32.807) were independent predictors of ICU death.Receiver operating characteristic curve analysis demonstrated that administration of norepinephrine ≥0.7 μg/kg per minute resulted in a sensitivity of 75.9%and a specificity of 90.3%for the likelihood of ICU death.In patients who received norepinephrine ≥0.7 μg/kg per minute there was more ICU death(71.4%vs.44.8%) and in-hospital death(76.2%vs.48.3%) than in those who received norepinephrine <0.7 ug/kg per minute.These patients had also a decreased 510-day survival rate compared with those who received norepinephrine <0.7 μg/kg per minute(19.2%vs.64.2%).CONCLUSION:Septic shock,SAPS 3 score at ICU admission,and norepinephrine administration were independent predictors of ICU death for patients with shock.Patients who received norepinephrine ≥0.7 μg/kg per minute had an increased ICU mortality,an increased inhospital mortality,and a decreased 510-day survival rate.展开更多
Intravenous(IV)vasopressors are essential in the management of hypotension and shock.Initiation of oral vasoactive agents to facilitate weaning of IV vasopressors to liberate patients from the intensive care unit is c...Intravenous(IV)vasopressors are essential in the management of hypotension and shock.Initiation of oral vasoactive agents to facilitate weaning of IV vasopressors to liberate patients from the intensive care unit is common despite conflicting evidence regarding the benefits of this practice.While midodrine appears to be the most frequently studied oral vasoactive agent for this purpose,its adverse effect profile may preclude its use in certain populations.In addition,some patients may require persistent use of IV vasopressors for hypotension refractory to midodrine.The use of additional and alternative oral vasoactive agents bearing different mechanisms of action is emerging.This article provides a comprehensive review of the pharmacology,clinical uses,dosing strategies,and safety considerations of oral vasoactive agents and their application in the inten-sive care setting.展开更多
Septic shock treatment remains a major challenge for intensive care units,despite the recent prominent advances in both management and outcomes.Vasopressors serve as a cornerstone of septic shock therapy,but there is ...Septic shock treatment remains a major challenge for intensive care units,despite the recent prominent advances in both management and outcomes.Vasopressors serve as a cornerstone of septic shock therapy,but there is still controversy over the timing of administration.Specifically,it remains unclear whether vasopressors should be used early in the course of treatment.Here,we provide a systematic review of the literature on the timing of vasopressor administration.Research was systematically identified through PubMed,Embase and Cochrane searching according to PRISMA guidelines.Fourteen studies met the eligibility criteria and were included in the review.The pathophysiological basis for early vasopressor use was classified,with the exploration on indications for the early administration of mono-vasopressors or their combination with vasopressin or angiotensinII.We found that mortality was 28.1%-47.7%in the early vasopressors group,and 33.6%-54.5%in the control group.We also investigated the issue of vasopressor responsiveness.Furthermore,we acknowledged the subsequent challenge of administration of high-dose norepinephrine via peripheral veins with early vasopressor use.Based on the literature review,we propose a possible protocol for the early initiation of vasopressors in septic shock resuscitation.展开更多
Objective:To evaluate the safety and effectiveness of intermittent bolus administration of ephedrine,norepinephrine,and phenylephrine in the treatment of maternal hypotension during spinal anesthesia for cesarean sect...Objective:To evaluate the safety and effectiveness of intermittent bolus administration of ephedrine,norepinephrine,and phenylephrine in the treatment of maternal hypotension during spinal anesthesia for cesarean sections in preeclamptic women.Methods:This PRISMA-based systematic review included English random control trails(RCTs)of women with singleton preeclampsia(American College of Obstetricians and Gynecologists(ACOG)criteria)undergoing cesarean delivery with spinal anesthesia,excluding chronic hypertension or systemic disease.Interventions were intermittent bolus phenylephrine,norepinephrine,or ephedrine,with outcomes on maternal hemodynamics,neonatal status,and adverse events.Searches of PubMed,ScienceDirect,Google Scholar,and Cochrane(to December 2024)plus reference screening identified eligible studies.Two reviewers independently selected studies,extracted data,and assessed risk of bias(Cochrane RoB 2.0).Due to heterogeneity in vasopressor regimens and outcome measures,results were synthesized narratively.Results:Of 2333 records screened,six RCTs(sample sizes 20-166)were included,all in preeclamptic women undergoing cesarean delivery.Overall risk of bias was low.Norepinephrine better preserved maternal hemodynamics than phenylephrine or ephedrine,with higher cardiac output(6.31±1.08 vs.5.45±1.21 L/min;P=0.009)and lower uteroplacental resistance(0.04±0.02 vs.0.06±0.03;P=0.002).Ephedrine caused higher heart rates(84.9±7.1 vs.76.6±6.9 bpm;P<0.05)and more nausea/vomiting.Neonatal umbilical artery pH was higher with norepinephrine or phenylephrine than ephedrine(7.32±0.02 vs.7.31±0.03;P<0.050),while Apgar scores did not differ.Adverse events favored norepinephrine,which reduced bradycardia versus phenylephrine(5.1%vs.20.5%;relative risk(RR)=0.25;P=0.042)and tachycardia versus ephedrine(16.1%vs.36.4%;RR=0.54;P=0.020).Conclusion:Intermittent bolus administration of norepinephrine offers superior maternal cardiac output and neonatal safety,making it optimal for preeclamptic cesarean deliveries.Phenylephrine is effective for blood pressure control but may induce bradycardia,while the use of ephedrine is limited by its association with neonatal acidosis.Tailored vasopressor selection is thus essential for optimal outcomes.展开更多
Introduction Sepsis is a syndrome in which the organism’s response to infection is dysregulated,which is characterised by rapid progression of the disease,and if it is not treated in time,it is very likely to lead to...Introduction Sepsis is a syndrome in which the organism’s response to infection is dysregulated,which is characterised by rapid progression of the disease,and if it is not treated in time,it is very likely to lead to other serious complications,which ultimately leads to organ dysfunction and endangers the patient’s life[1].So far,sepsis remains a world public health problem,and according to an analysis of global sepsis data in 2020[2],the number of sepsis cases has increased significantly,with approximately 45 million new cases and 11 million deaths in 2017.According to statistics published in 2021,sepsis accounts for 20%of global deaths[3].Personalised clinical treatment options now available for sepsis include targeted antibiotics and combination therapy,vasopressor therapy,fluid resuscitation,immunomodulatory approaches,and organ-supportive therapy[4].These personalised therapeutic strategies are essential to reduce the complications associated with sepsis.In addition,extracellular vesicles have been found to play an important role in sepsis as a novel biomarker of pathology and diagnosis[5].Therefore,we believe that with the development of medicine,the understanding of sepsis will become more in-depth and comprehensive,and the protracted war with sepsis will certainly achieve new breakthroughs.展开更多
BACKGROUND Refractory septic shock is a critical and multifaceted condition that continues to pose significant challenges in critical care.AIM To systematically review randomized trials on emerging interventions for r...BACKGROUND Refractory septic shock is a critical and multifaceted condition that continues to pose significant challenges in critical care.AIM To systematically review randomized trials on emerging interventions for refractory septic shock,assessing mortality,vasopressor use,intensive care unit(ICU)length of stay,and organ dysfunction.METHODS A systematic search was conducted in PubMed,EMBASE,Cochrane CENTRAL Library,and Web of Science for studies published between 2000 and 2024.Inclusion criteria encompassed randomized controlled trials(RCT)evaluating innovative therapies for refractory septic shock.Variables of interest:The primary outcome was allcause mortality among patients treated with novel interventions.Secondary outcomes included length of stay in the ICU,total hospital length of stay,and use of vasoactive drugs.Methodological rigor was assessed using the Cochrane Risk of Bias tool.RESULTS From 850 records,24 RCTs met the inclusion criteria,evaluating therapies such as methylene blue,vasopressin,terlipressin,and combinations of hydrocortisone,vitamin C,and thiamine.Mortality rates ranged from 28.6%to 56.8%.Methylene blue reduced vasopressor dependency in patients requiring high norepinephrine doses by 1.0 vasopressor-free day,and terlipressin improved renal perfusion by 13.1%.Combination therapies enhanced secondary outcomes,including reductions in Sequential Organ Failure Assessment score.However,no single intervention consistently demonstrated significant survival benefits.CONCLUSION Adjunctive therapies for refractory septic shock may improve hemodynamics and organ function,however,they have not been shown to consistently reduce mortality.Larger trials are needed to confirm these findings.Multimodal approaches targeting inflammation are critical.展开更多
Hepatorenal syndrome(HRS) plays an important role in patients with liver cirrhosis on the wait list for liver transplantation(LT). The 1 and 5-year probability of developing HRS in cirrhotic with ascites is 20% and 40...Hepatorenal syndrome(HRS) plays an important role in patients with liver cirrhosis on the wait list for liver transplantation(LT). The 1 and 5-year probability of developing HRS in cirrhotic with ascites is 20% and 40%, respectively. In this article, we reviewed current concepts in HRS pathophysiology, guidelines for HRS diagnosis, effective treatment options presently available, and controversies surrounding liver alone vs simultaneous liver kidney transplant(SLKT) in transplant candidates. Many treatment options including albumin, vasoconstrictors, renal replacement therapy, and eventual LT have remained a mainstay in the treatment of HRS. Unfortunately, even after aggressive measures such as terlipressin use, the rate of recovery is less than 50% of patients. Moreover, current SLKT guidelines include:(1) estimation of glomerular filtration rate of 30 m L/min or less for 4-8 wk;(2) proteinuria > 2 g/d; or(3) biopsy proven interstitial fibrosis or glomerulosclerosis. Even with these updated criteria there is a lack of consistency regarding longterm benefits for SLKT vs LT alone. Finally, in regards to kidney dysfunction in the post-transplant setting, an estimation of glomerular filtration rate < 60 mL /min per 1.73 m2 may be associated with an increased risk of patients having long-term end stage renal disease. HRS is common in patients with cirrhosis and those on liver transplant waitlist. Prompt identification and therapy initiation in transplant candidates with HRS may improve post-transplantation outcomes. Future studies identifying optimal vasoconstrictor regimens, alternative therapies, and factors predictive of response to therapy are needed. The appropriate use of SLKT in patients with HRS remains controversial and requires further evidence by the transplant community.展开更多
Ascorbic acid(vitamin C) elicits pleiotropic effects in thebody. Among its functions, it serves as a potent antioxidant, a co-factor in collagen and catecholamine synthesis, and a modulator of immune cell biology. Fur...Ascorbic acid(vitamin C) elicits pleiotropic effects in thebody. Among its functions, it serves as a potent antioxidant, a co-factor in collagen and catecholamine synthesis, and a modulator of immune cell biology. Furthermore, an increasing body of evidence suggests that highdose vitamin C administration improves hemodynamics, end-organ function, and may improve survival in critically ill patients. This article reviews studies that evaluate vitamin C in pre-clinical models and clinical trials with respect to its therapeutic potential.展开更多
Acute kidney injury（AKI） is a common complication following orthotopic liver transplantation（OLT） and is associated with increased morbidity and mortality. The aim of the current study was to determine the risk fa...Acute kidney injury（AKI） is a common complication following orthotopic liver transplantation（OLT） and is associated with increased morbidity and mortality. The aim of the current study was to determine the risk factors for AKI in patients undergoing OLT. A total of 103 patients who received OLT between January 2015 and May 2016 in Tongji Hospital, China, were retrospectively analyzed. Their demographic characteristics and perioperative parameters were collected, and AKI was diagnosed using 2012 Kidney Disease： Improving Global Outcomes（KDIGO） staging criteria. It was found that the incidence of AKI was 40.8% in this cohort and AKI was significantly associated with body mass index, urine volume, operation duration（especially 〉 480 min）, and the postoperative use of vasopressors. It was concluded that relative low urine output, long operation duration, and the postoperative use of vasopressors are risk factors for AKI following OLT.展开更多
文摘Vasopressors are routinely used to counteract hypotension after neuraxial anesthesia in Obstetrics. The understanding of the mechanism of hypotension and the choice of vasopressor has evolved over the years to a point where phenylephrine has become the preferred vasopressor. Due to the absence of definitive evidence showing absolute clinical benefit of one over the other, especially in emergency and high-risk Cesarean sections, our choice of phenylephrine over the other vasopressors like mephentermine, metaraminol, and ephedrine is guided by indirect evidence on fetalacid-base status. This review article evaluates the present day evidence on the various vasopressors used in obstetric anesthesia today.
文摘BACKGROUND:Consensus guidelines suggested that both dopamine and norepinephrine may be used,but specific doses are not recommended.The aim of this study is to determine the predictive role of vasopressors in patients with shock in intensive care unit.METHODS:One hundred and twenty-two patients,who had received vasopressors for 1 hour or more in intensive care unit(ICU) between October 2008 and October 2011,were included.There were 85 men and 37 women,with a median age of 65 years(55-73 years).Their clinical data were retrospectively collected and analyzed.RESULTS:The median simplified acute physiological score 3(SAPS 3) was 50(42-55).Multivariate analysis showed that septic shock(P=0.018,relative risk:4.094;95%confidential interval:1.274-13.156),SAPS 3 score at ICU admission(P=0.028,relative risk:1.079;95%confidential interval:1.008-1.155),and norepinephrine administration(P<0.001,relative risk:9.353;95%confidential interval:2.667-32.807) were independent predictors of ICU death.Receiver operating characteristic curve analysis demonstrated that administration of norepinephrine ≥0.7 μg/kg per minute resulted in a sensitivity of 75.9%and a specificity of 90.3%for the likelihood of ICU death.In patients who received norepinephrine ≥0.7 μg/kg per minute there was more ICU death(71.4%vs.44.8%) and in-hospital death(76.2%vs.48.3%) than in those who received norepinephrine <0.7 ug/kg per minute.These patients had also a decreased 510-day survival rate compared with those who received norepinephrine <0.7 μg/kg per minute(19.2%vs.64.2%).CONCLUSION:Septic shock,SAPS 3 score at ICU admission,and norepinephrine administration were independent predictors of ICU death for patients with shock.Patients who received norepinephrine ≥0.7 μg/kg per minute had an increased ICU mortality,an increased inhospital mortality,and a decreased 510-day survival rate.
文摘Intravenous(IV)vasopressors are essential in the management of hypotension and shock.Initiation of oral vasoactive agents to facilitate weaning of IV vasopressors to liberate patients from the intensive care unit is common despite conflicting evidence regarding the benefits of this practice.While midodrine appears to be the most frequently studied oral vasoactive agent for this purpose,its adverse effect profile may preclude its use in certain populations.In addition,some patients may require persistent use of IV vasopressors for hypotension refractory to midodrine.The use of additional and alternative oral vasoactive agents bearing different mechanisms of action is emerging.This article provides a comprehensive review of the pharmacology,clinical uses,dosing strategies,and safety considerations of oral vasoactive agents and their application in the inten-sive care setting.
文摘Septic shock treatment remains a major challenge for intensive care units,despite the recent prominent advances in both management and outcomes.Vasopressors serve as a cornerstone of septic shock therapy,but there is still controversy over the timing of administration.Specifically,it remains unclear whether vasopressors should be used early in the course of treatment.Here,we provide a systematic review of the literature on the timing of vasopressor administration.Research was systematically identified through PubMed,Embase and Cochrane searching according to PRISMA guidelines.Fourteen studies met the eligibility criteria and were included in the review.The pathophysiological basis for early vasopressor use was classified,with the exploration on indications for the early administration of mono-vasopressors or their combination with vasopressin or angiotensinII.We found that mortality was 28.1%-47.7%in the early vasopressors group,and 33.6%-54.5%in the control group.We also investigated the issue of vasopressor responsiveness.Furthermore,we acknowledged the subsequent challenge of administration of high-dose norepinephrine via peripheral veins with early vasopressor use.Based on the literature review,we propose a possible protocol for the early initiation of vasopressors in septic shock resuscitation.
文摘Objective:To evaluate the safety and effectiveness of intermittent bolus administration of ephedrine,norepinephrine,and phenylephrine in the treatment of maternal hypotension during spinal anesthesia for cesarean sections in preeclamptic women.Methods:This PRISMA-based systematic review included English random control trails(RCTs)of women with singleton preeclampsia(American College of Obstetricians and Gynecologists(ACOG)criteria)undergoing cesarean delivery with spinal anesthesia,excluding chronic hypertension or systemic disease.Interventions were intermittent bolus phenylephrine,norepinephrine,or ephedrine,with outcomes on maternal hemodynamics,neonatal status,and adverse events.Searches of PubMed,ScienceDirect,Google Scholar,and Cochrane(to December 2024)plus reference screening identified eligible studies.Two reviewers independently selected studies,extracted data,and assessed risk of bias(Cochrane RoB 2.0).Due to heterogeneity in vasopressor regimens and outcome measures,results were synthesized narratively.Results:Of 2333 records screened,six RCTs(sample sizes 20-166)were included,all in preeclamptic women undergoing cesarean delivery.Overall risk of bias was low.Norepinephrine better preserved maternal hemodynamics than phenylephrine or ephedrine,with higher cardiac output(6.31±1.08 vs.5.45±1.21 L/min;P=0.009)and lower uteroplacental resistance(0.04±0.02 vs.0.06±0.03;P=0.002).Ephedrine caused higher heart rates(84.9±7.1 vs.76.6±6.9 bpm;P<0.05)and more nausea/vomiting.Neonatal umbilical artery pH was higher with norepinephrine or phenylephrine than ephedrine(7.32±0.02 vs.7.31±0.03;P<0.050),while Apgar scores did not differ.Adverse events favored norepinephrine,which reduced bradycardia versus phenylephrine(5.1%vs.20.5%;relative risk(RR)=0.25;P=0.042)and tachycardia versus ephedrine(16.1%vs.36.4%;RR=0.54;P=0.020).Conclusion:Intermittent bolus administration of norepinephrine offers superior maternal cardiac output and neonatal safety,making it optimal for preeclamptic cesarean deliveries.Phenylephrine is effective for blood pressure control but may induce bradycardia,while the use of ephedrine is limited by its association with neonatal acidosis.Tailored vasopressor selection is thus essential for optimal outcomes.
文摘Introduction Sepsis is a syndrome in which the organism’s response to infection is dysregulated,which is characterised by rapid progression of the disease,and if it is not treated in time,it is very likely to lead to other serious complications,which ultimately leads to organ dysfunction and endangers the patient’s life[1].So far,sepsis remains a world public health problem,and according to an analysis of global sepsis data in 2020[2],the number of sepsis cases has increased significantly,with approximately 45 million new cases and 11 million deaths in 2017.According to statistics published in 2021,sepsis accounts for 20%of global deaths[3].Personalised clinical treatment options now available for sepsis include targeted antibiotics and combination therapy,vasopressor therapy,fluid resuscitation,immunomodulatory approaches,and organ-supportive therapy[4].These personalised therapeutic strategies are essential to reduce the complications associated with sepsis.In addition,extracellular vesicles have been found to play an important role in sepsis as a novel biomarker of pathology and diagnosis[5].Therefore,we believe that with the development of medicine,the understanding of sepsis will become more in-depth and comprehensive,and the protracted war with sepsis will certainly achieve new breakthroughs.
文摘BACKGROUND Refractory septic shock is a critical and multifaceted condition that continues to pose significant challenges in critical care.AIM To systematically review randomized trials on emerging interventions for refractory septic shock,assessing mortality,vasopressor use,intensive care unit(ICU)length of stay,and organ dysfunction.METHODS A systematic search was conducted in PubMed,EMBASE,Cochrane CENTRAL Library,and Web of Science for studies published between 2000 and 2024.Inclusion criteria encompassed randomized controlled trials(RCT)evaluating innovative therapies for refractory septic shock.Variables of interest:The primary outcome was allcause mortality among patients treated with novel interventions.Secondary outcomes included length of stay in the ICU,total hospital length of stay,and use of vasoactive drugs.Methodological rigor was assessed using the Cochrane Risk of Bias tool.RESULTS From 850 records,24 RCTs met the inclusion criteria,evaluating therapies such as methylene blue,vasopressin,terlipressin,and combinations of hydrocortisone,vitamin C,and thiamine.Mortality rates ranged from 28.6%to 56.8%.Methylene blue reduced vasopressor dependency in patients requiring high norepinephrine doses by 1.0 vasopressor-free day,and terlipressin improved renal perfusion by 13.1%.Combination therapies enhanced secondary outcomes,including reductions in Sequential Organ Failure Assessment score.However,no single intervention consistently demonstrated significant survival benefits.CONCLUSION Adjunctive therapies for refractory septic shock may improve hemodynamics and organ function,however,they have not been shown to consistently reduce mortality.Larger trials are needed to confirm these findings.Multimodal approaches targeting inflammation are critical.
文摘Hepatorenal syndrome(HRS) plays an important role in patients with liver cirrhosis on the wait list for liver transplantation(LT). The 1 and 5-year probability of developing HRS in cirrhotic with ascites is 20% and 40%, respectively. In this article, we reviewed current concepts in HRS pathophysiology, guidelines for HRS diagnosis, effective treatment options presently available, and controversies surrounding liver alone vs simultaneous liver kidney transplant(SLKT) in transplant candidates. Many treatment options including albumin, vasoconstrictors, renal replacement therapy, and eventual LT have remained a mainstay in the treatment of HRS. Unfortunately, even after aggressive measures such as terlipressin use, the rate of recovery is less than 50% of patients. Moreover, current SLKT guidelines include:(1) estimation of glomerular filtration rate of 30 m L/min or less for 4-8 wk;(2) proteinuria > 2 g/d; or(3) biopsy proven interstitial fibrosis or glomerulosclerosis. Even with these updated criteria there is a lack of consistency regarding longterm benefits for SLKT vs LT alone. Finally, in regards to kidney dysfunction in the post-transplant setting, an estimation of glomerular filtration rate < 60 mL /min per 1.73 m2 may be associated with an increased risk of patients having long-term end stage renal disease. HRS is common in patients with cirrhosis and those on liver transplant waitlist. Prompt identification and therapy initiation in transplant candidates with HRS may improve post-transplantation outcomes. Future studies identifying optimal vasoconstrictor regimens, alternative therapies, and factors predictive of response to therapy are needed. The appropriate use of SLKT in patients with HRS remains controversial and requires further evidence by the transplant community.
文摘Ascorbic acid(vitamin C) elicits pleiotropic effects in thebody. Among its functions, it serves as a potent antioxidant, a co-factor in collagen and catecholamine synthesis, and a modulator of immune cell biology. Furthermore, an increasing body of evidence suggests that highdose vitamin C administration improves hemodynamics, end-organ function, and may improve survival in critically ill patients. This article reviews studies that evaluate vitamin C in pre-clinical models and clinical trials with respect to its therapeutic potential.
基金supported by the National Natural Science Foundation of China(No.81371251)
文摘Acute kidney injury（AKI） is a common complication following orthotopic liver transplantation（OLT） and is associated with increased morbidity and mortality. The aim of the current study was to determine the risk factors for AKI in patients undergoing OLT. A total of 103 patients who received OLT between January 2015 and May 2016 in Tongji Hospital, China, were retrospectively analyzed. Their demographic characteristics and perioperative parameters were collected, and AKI was diagnosed using 2012 Kidney Disease： Improving Global Outcomes（KDIGO） staging criteria. It was found that the incidence of AKI was 40.8% in this cohort and AKI was significantly associated with body mass index, urine volume, operation duration（especially 〉 480 min）, and the postoperative use of vasopressors. It was concluded that relative low urine output, long operation duration, and the postoperative use of vasopressors are risk factors for AKI following OLT.
