Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

INFLUENCE OF DIETARY GRADED LEVELS OF DIGESTIBLE LYSINE AND LOWERING ENERGY TO PROTEIN RATIO ON THE GROWTH PERFORMANCE OF BROILERS UNDER SUBTROPICAL SUMMER CONDITIONS

ABSTRACTThe digestible lysine requirement for the growth performance of broilers fed diets with decreasing energy to protein ratio and reared under subtropical summer conditions were determined. Treatments consisted of five wheat-based diets with five levels (0.90, 0.95, 1.00, 1.05 and 1.10%) of digestible lysine (DL) and lowering energy to protein ratio (EPR; 13.6, 12.8, 12.0, 11.4 and 11.0), with five replicates of 80 birds each (n = 2000). Body weight gain (BWG) significantly increased by increasing DL levels during wk 1 (p<0.001), while 1.05% DL promoted the highest BWG during the whole experimental period (p<0.01). Increasing DL level resulted in significant reduction in feed intake (FI) and BWG to DL intake ratio (BWG:DLI) during wk 1-3 (p<0.05). Feed:gain ratio (FGR) significantly (p<0.01) improved with DL levels up to 1.05% during the whole experimental period, except for wk 5. The increasing ambient temperature had a linear effect on the all growth parameters. It is inferred that best growth performance can be obtained at 1.05% DL, maintaining all other AA constant under subtropical summer conditions