The clinical outcome of minor changes in serum creatinine for patients after curative gastrectomy: a prospective study

TL;DR

This study shows that small changes in blood creatinine after stomach cancer surgery can predict complications, helping doctors identify high-risk patients.

Contribution

The study introduces a nomogram model that reliably predicts postoperative complications in gastric cancer patients based on serum creatinine changes.

Findings

Reduced serum creatinine after surgery is a protective factor against postoperative complications.

Elevated serum creatinine is an independent risk factor for severe postoperative complications.

A predictive nomogram model achieved a c-index of 0.715 for identifying patients at risk of complications.

Abstract

Patients with renal insufficiency are more prone to postoperative complications (PCs). Studies have shown that minor changes in serum creatinine (SCr), immediately post-surgery, can aid in assessing patients’ renal function. This study aimed to explore the relationship between the changes in SCr and PCs in patients with gastric cancer (GC).

We prospectively collected data regarding the SCr of 530 GC patients, within 2 weeks before surgery and within 24 hours after surgery in our hospital (2014–2016). The patients were divided into three groups according to the level of SCr change after surgery: reduced (<10%), normal (10%), and elevated (>10%) creatinine groups. Univariate and multivariate logistic analysis were performed to evaluate its correlation with short-term PCs in the patients. The R language was used to construct a nomogram.

83, 217, and 230 patients were assigned to the elevated, reduced, and normal SCr groups, respectively. Multivariate analysis showed that the reduced and elevated SCr groups were independently associated with the occurrence of PCs and severe postoperative complications (SPCs), respectively. Additionally, postsurgical SCr change, age, hypoalbuminemia, total gastrectomy, combined resection, and laparoscopy, were independently related to PCs. Combining the above influential factors, the predictive model can distinguish patients with PCs more reliably (c-index is 0.715).

Post-surgery, reduced SCr is a protective factor for PCs, while elevated serum creatinine is an independent risk factor for SPCs. Our nomogram can identify GC patients with high risks of PCs.

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