{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T14:13:18Z","timestamp":1778595198045,"version":"3.51.4"},"reference-count":46,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: We aim to identify the postoperative acute kidney injury (AKI) risk factors and the predictors of severe AKI derived from routine perioperative elements in patients with aortoiliac occlusive disease who underwent aorto-bifemoral bypass as arterial revascularization. This involves a dynamic assessment throughout the perioperative period. Methods: Preoperative, intraoperative, early postoperative and day-one-after-surgery data were retrospectively reviewed in consecutive patients who underwent elective aorto-bifemoral bypass for aortoiliac occlusive disease classified as TASC II D at the \u201cProf. C.C. Iliescu\u201d Emergency Institute for Cardiovascular Diseases in Bucharest, Romania, between 2017 and 2023. Results: Preoperative clearance of creatinine (OR 1.037, CI95%: 1.009\u20131.066), the duration of the surgery (OR 1.435, CI 95%: 1.100\u20131.873), and the change between the day-one-after-surgery and preoperative systemic inflammatory response index (DeltaSIRI_1_preop) (OR 1.080, CI 95%: 1.012\u20131.152) were identified as independent risk factors for postoperative AKI in patients undergoing aorto-bifemoral revascularization for aortoiliac occlusive disease. The most severe form of AKI was strongly predicted by the number of packed red blood cells transfused (AUC 0.924, p = 0.001), the patient\u2019s age (AUC 0.895, p = 0.001), and the duration of the surgery (AUC 0.895, p = 0.001). Furthermore, various routine and cost-effective variables related to the preoperative period, the early postoperative period, and the first day after surgery also demonstrated significant predictive value. Conclusions: We conducted a dynamic perioperative assessment of AKI associated with major vascular surgery. This aims to equip clinicians with a practical and cost-effective tool for evaluating AKI, thereby facilitating a more individualized approach to the diagnosis of this complication.<\/jats:p>","DOI":"10.3390\/diagnostics16091382","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T10:15:27Z","timestamp":1777630527000},"page":"1382","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Dynamic Approach to Assessing and Predicting AKI Risk in Patients with Aortoiliac Occlusive Disease Undergoing Aorto-Bifemoral Bypass"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2944-6527","authenticated-orcid":false,"given":"Anca","family":"Dr\u0103gan","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Anaesthesiology and Intensive Care, \u201cProf. Dr. C.C. Iliescu\u201d Emergency Institute for Cardiovascular Diseases, 258 Fundeni Road, 022328 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian \u015etefan","family":"Dr\u0103gan","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1007\/s00134-023-07169-7","article-title":"Epidemiology of surgery associated acute kidney injury (EPIS-AKI): A prospective international observational multi-center clinical study","volume":"49","author":"Zarbock","year":"2023","journal-title":"Intensive Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.avsg.2025.12.035","article-title":"Contemporary Results of Open Surgery for Aortoiliac Occlusive Disease","volume":"125","author":"Sfyroeras","year":"2026","journal-title":"Ann. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.avsg.2023.06.023","article-title":"Persistent Acute Kidney Injury is Associated with Poor Outcomes and Increased Hospital Cost in Vascular Surgery","volume":"98","author":"Filiberto","year":"2024","journal-title":"Ann. Vasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"833","DOI":"10.2215\/CJN.12591117","article-title":"Acute Kidney Injury and Risk of Heart Failure and Atherosclerotic Events","volume":"13","author":"Go","year":"2018","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.semnephrol.2016.05.005","article-title":"The Role of Acute Kidney Injury in Chronic Kidney Disease","volume":"36","author":"Hsu","year":"2016","journal-title":"Semin. Nephrol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Yeh, T.-H., Tu, K.-C., Wang, H.-Y., and Chen, J.-Y. (2024). From Acute to Chronic: Unraveling the Pathophysiological Mechanisms of the Progression from Acute Kidney Injury to Acute Kidney Disease to Chronic Kidney Disease. Int. J. Mol. Sci., 25.","DOI":"10.20944\/preprints202401.0620.v1"},{"key":"ref_7","first-page":"80","article-title":"Statistical analysis plan for the biomarker-guided intervention to prevent acute kidney injury after major surgery (BigpAK-2) study: An international randomised controlled multicentre trial","volume":"26","author":"Danzer","year":"2024","journal-title":"Crit. Care Resusc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1007\/s00268-022-06878-2","article-title":"Association of Preoperative Neutrophil-to-Lymphocyte Ratio with Postoperative Acute Kidney Injury and Mortality Following Major Noncardiac Surgeries","volume":"47","author":"Wang","year":"2023","journal-title":"World J. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Xie, H., Zheng, K., Wang, K., Zhao, Z., Si, R., Xiao, J., Yin, Y., and Zhu, X. (2026). Systemic inflammatory response index is associated with acute kidney injury following cardiac surgery: A retrospective cohort study using the MIMIC database. PLoS ONE, 21.","DOI":"10.1371\/journal.pone.0342780"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3538","DOI":"10.1093\/eurheartj\/ehae179","article-title":"2024 ESC Guidelines for the management of peripheral arterial and aortic diseases","volume":"45","author":"Mazzolai","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_11","first-page":"1","article-title":"Kidney disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury","volume":"2","author":"Kellum","year":"2012","journal-title":"Kidney Int. Suppl."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"683.e1","DOI":"10.1016\/j.jvs.2010.03.031","article-title":"Vascular Study Group of New England. The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac complications more accurately than the Revised Cardiac Risk Index in vascular surgery patients","volume":"52","author":"Bertges","year":"2010","journal-title":"J. Vasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1161\/01.CIR.100.10.1043","article-title":"Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery","volume":"100","author":"Lee","year":"1999","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1016\/j.jvs.2018.05.017","article-title":"Epidemiology, outcomes, and management of acute kidney injury in the vascular surgery patient","volume":"68","author":"Hobson","year":"2018","journal-title":"J. Vasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.jvs.2025.10.009","article-title":"The Society for Vascular Surgery Vascular Quality Initiative underestimates the risk associated with mild postoperative acute kidney injury","volume":"83","author":"Filiberto","year":"2026","journal-title":"J. Vasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Turgut, F., Awad, A.S., and Abdel-Rahman, E.M. (2023). Acute Kidney Injury: Medical Causes and Pathogenesis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12010375"},{"key":"ref_17","first-page":"311","article-title":"Perioperative Acute Kidney Injury and Anesthesia: A Narrative Review","volume":"46","author":"Uslu","year":"2024","journal-title":"J. Clin. Pract. Res."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Dr\u0103gan, A., and Sinescu, I. (2023). AKI3-Risk Predictors and Scores in Radical Nephrectomy with High Thrombectomy under Extracorporeal Circulation for Renal Cell Carcinoma with Supradiaphragmatic Inferior Vena Cava\/Right Atrial Thrombus: A Single-Centre Retrospective Study. Medicina, 59.","DOI":"10.3390\/medicina59020386"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1177\/17085381211067616","article-title":"Cross-clamp location and perioperative outcomes after open infrarenal abdominal aortic aneurysm repair: A Vascular Quality Initiative\u00ae review","volume":"31","author":"Natour","year":"2023","journal-title":"Vascular"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e008834","DOI":"10.1161\/JAHA.118.008834","article-title":"Cardiac and Vascular Surgery-Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group","volume":"7","author":"Nadim","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"De Guglielmo, W., Rebibou, J.M., Aho, S., Rogier, T., Nuemi, G., Girard, C., Steinmetz, E., and Legendre, M. (2022). Pre-Operative Factors Associated with the Occurrence of Acute Kidney Injury in Patients Aged 65 Years and Over Undergoing Non-Ambulatory Non-Cardiac Surgery. Healthcare, 10.","DOI":"10.3390\/healthcare10030558"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"6303","DOI":"10.1097\/MS9.0000000000003699","article-title":"Prediction of acute kidney injury after noncardiac surgery in intensive care unit by machine learning","volume":"87","author":"Chen","year":"2025","journal-title":"Ann. Med. Surg."},{"key":"ref_23","first-page":"e89155","article-title":"Incidence and Clinical Outcomes of Postoperative Acute Kidney Injury in Relation to Etiological Factors and Surgical Procedures","volume":"17","author":"Tahir","year":"2025","journal-title":"Cureus"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1417075","DOI":"10.1155\/mi\/1417075","article-title":"The Systemic Inflammation Response Index as an Independent Predictor of Acute Kidney Injury in Critically Ill Patients with Acute Myocardial Infarction: Insights from a Large-Scale Cohort Study","volume":"2025","author":"Li","year":"2025","journal-title":"Mediat. Inflamm."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2330621","DOI":"10.1080\/0886022X.2024.2330621","article-title":"The association between systemic inflammatory response index and contrast-associated acute kidney injury in patients undergoing elective percutaneous coronary intervention","volume":"46","author":"Chen","year":"2024","journal-title":"Ren. Fail."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1182\/bloodadvances.2022008419","article-title":"Vascular surgery patients with elevated neutrophil-to-lymphocyte ratios have downregulated neutrophil complement RNA expression","volume":"7","author":"Chan","year":"2023","journal-title":"Blood Adv."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Pereira-Neves, A., Dias, L., Frag\u00e3o-Marques, M., Vidoedo, J., Ribeiro, H., Andrade, J.P., and Rocha-Neves, J. (2024). Monocyte Count as a Predictor of Major Adverse Limb Events in Aortoiliac Revascularization. J. Clin. Med., 13.","DOI":"10.3390\/jcm13216412"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1186\/s13054-024-05099-4","article-title":"Lymphopenia in sepsis: A narrative review","volume":"28","author":"Wang","year":"2024","journal-title":"Crit. Care"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Hohlstein, P., Gussen, H., Bartneck, M., Warzecha, K.T., Roderburg, C., Buendgens, L., Trautwein, C., Koch, A., and Tacke, F. (2019). Prognostic Relevance of Altered Lymphocyte Subpopulations in Critical Illness and Sepsis. J. Clin. Med., 8.","DOI":"10.3390\/jcm8030353"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1007\/s12630-025-03036-9","article-title":"Blood transfusion and acute kidney injury after cardiac surgery: A retrospective observational study","volume":"72","author":"Boyko","year":"2025","journal-title":"Can. J. Anesth."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Merchant, A.M., Neyra, J.A., Minhajuddin, A., Wehrmann, L.E., Mills, R.A., Gualano, S.K., Kumbhani, D.J., Huffman, L.C., Jessen, M.E., and Fox, A.A. (2019). Packed red blood cell transfusion associates with acute kidney injury after transcatheter aortic valve replacement. BMC Anesthesiol., 19.","DOI":"10.1186\/s12871-019-0764-0"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.amjsurg.2019.01.031","article-title":"Perioperative risk factors of acute kidney injury after non-cardiac surgery: A multicenter, prospective, observational study in patients with low grade American Society of Anesthesiologists physical status","volume":"218","author":"Iyigun","year":"2019","journal-title":"Am. J. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1097\/ACO.0000000000000171","article-title":"Perioperative renal failure in elderly patients","volume":"28","author":"Bellomo","year":"2015","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Dr\u0103gan, A., and Dr\u0103gan, A.\u015e. (2025). New Insights in Assessing AKI 3 Risk Factors and Predictors Associated with On-Pump Surgical Aortic Valve Replacement. Diagnostics, 15.","DOI":"10.3390\/diagnostics15172211"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"255","DOI":"10.5603\/CJ.a2020.0070","article-title":"Erythrocyte transfusion limits the role of elevated red cell distribution width on predicting cardiac surgery associated acute kidney injury","volume":"28","author":"Jiang","year":"2021","journal-title":"Cardiol. J."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Marianello, D., Puddu, A., Biuzzi, C., Fogagnolo, A., Spadaro, S., Galasso, L., Cartocci, A., De Matteis, F.L., Sponga, S., and Taccone, F.S. (2026). Prognostic Value of Red Blood Cell Distribution Width in Predicting Acute Kidney Injury After Cardiac Surgery: A Retrospective Cohort Study. J. Clin. Med., 15.","DOI":"10.3390\/jcm15062403"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"S2185","DOI":"10.4103\/jpbs.jpbs_145_24","article-title":"Role of Mean Platelet Volume (MPV) as a Prognostic Marker in Patients with Acute Kidney Injury","volume":"16","author":"Singh","year":"2024","journal-title":"J. Pharm. Bioallied Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1016\/j.jcrc.2014.07.022","article-title":"Mean platelet volume is a prognostic factor in patients with acute kidney injury requiring continuous renal replacement therapy","volume":"29","author":"Han","year":"2014","journal-title":"J. Crit. Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"6694313","DOI":"10.1155\/2023\/6694313","article-title":"Evaluation of Platelet Distribution Width as an Early Predictor of Acute Kidney Injury in Extensive Burn Patients","volume":"2023","author":"Jiang","year":"2023","journal-title":"Emerg. Med. Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"109778","DOI":"10.1016\/j.intimp.2023.109778","article-title":"Neutrophil-to-Lymphocyte ratio as a prognostic marker of mortality and disease severity in septic Acute kidney injury Patients: A retrospective study","volume":"116","author":"Wei","year":"2023","journal-title":"Int. Immunopharmacol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2417744","DOI":"10.1080\/0886022X.2024.2417744","article-title":"High neutrophil-to-lymphocyte ratio as a cost-effective marker of acute kidney injury and in-hospital mortality after cardiac surgery: A case-control study","volume":"46","author":"Hu","year":"2024","journal-title":"Ren. Fail."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Chrisant, E.M., Khamisi, R.H., Muhamba, F., Mwanga, A.H., and Mbuyamba, H.T. (2024). Assessing the accuracy of the revised Cardiac Risk Index compared to the American Society of Anaesthesiologists physical status classification in predicting Pulmonary and Cardiac complications among non-cardiothoracic surgery patients at Muhimbili National Hospital: A prospective cohort study. BMC Surg., 24.","DOI":"10.1186\/s12893-024-02536-7"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Dr\u0103gan, A., Dr\u0103gan, A.\u015e., and \u015etiru, O. (2024). The Predictive Value of Perioperative Inflammatory Indexes in Major Arterial Surgical Revascularization from Leriche Syndrome. J. Clin. Med., 13.","DOI":"10.3390\/jcm13216338"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Dr\u0103gan, A., and Dr\u0103gan, A.\u015e. (2024). The Preventive Role of Glutamine Supplementation in Cardiac Surgery-Associated Kidney Injury from Experimental Research to Clinical Practice: A Narrative Review. Medicina, 60.","DOI":"10.3390\/medicina60050761"},{"key":"ref_45","first-page":"116","article-title":"Inter-relationships between glutamine and other biochemical and immunological changes after major vascular surgery","volume":"53","author":"Greig","year":"1996","journal-title":"Br. J. Biomed. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1089\/dna.2019.5034","article-title":"Essential Role of Nonessential Amino Acid Glutamine in Atherosclerotic Cardiovascular Disease","volume":"39","author":"Chen","year":"2020","journal-title":"DNA Cell. Biol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1382\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T13:08:45Z","timestamp":1778591325000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1382"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,1]]},"references-count":46,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16091382"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16091382","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,1]]}}}