Predictive risk factors for acute kidney injury after surgery for Stanford type A acute aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHENG Wei ¹ , LUAN Tian ¹ , CHI Yifan ¹ , NIU Zhaozhuo ¹ , SUN Long ¹ , ZHANG Wenfeng ¹ , WU Jiantao ¹ ,  YANG Haiqin ²

1. Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, 266071, Shandong, P.R.China;
2. Department of Mental Intervention, Qingdao Preferential Hospital, Qingdao, 266071, Shandong, P.R.China;

Corresponding?author：

YANG Haiqin, Email: rose8118@126.com

Keywords：

Acute aortic dissection; acute kidney injury; risk factors

DOI：

10.7507/1007-4848.201804042

Video：

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Objective To identify the predictors of postoperative acute kidney injury in patients undergoing surgery for Stanford type A acute aortic dissection. Methods A total of 220 patients who underwent surgery for type A acute aortic dissection in Qingdao Municipal Hospital from September 2010 to September 2017 were divided into two groups including a group A and a group B based on whether acute kidney injury occurred or not after surgery. There were 40 patients with 29 males and 11 females with the mean age of 54.6±9.2 years in the group A, 180 patients with 133 males and 47 females with the mean age of 48.5±7.9 years in the group B. Univariate and multivariate analyses (logistic regression) were used to identify the predictive risk factors.Results Overall in-hospital mortality was 5.5%. In univariate analysis, there were statistically significant differences with respect to the age, preoperative creatinine, preoperative white blood cell, the European system for cardiac operative risk evaluation (EuroSCORE), total cardiopulmonary bypass (CPB) time, deep hypothermic circulatory arrest (DHCA) time, arch replacement, red blood cell transfusion intraoperative and in 24 hours postoperatively, postoperative mechanical ventilation time, ICU stay duration, hospital stay duration and in hospital mortality. Multivariate logistic analysis showed that preoperative creatinine, preoperative white blood cell, CPB time, and red blood cell transfusion intraoperative and in 24 hours postoperatively were the independent predictors for postoperative acute kidney injury.Conclusion The incidence of acute kidney injury is high after surgery for acute Stanford type A aortic dissection. It can be predicted based on above factors, for patients with these risk factors, more perioperative care strategies are needed in order to induce the incidence of acute kidney injury.

Citation： SHENG Wei, LUAN Tian, CHI Yifan, NIU Zhaozhuo, SUN Long, ZHANG Wenfeng, WU Jiantao, YANG Haiqin. Predictive risk factors for acute kidney injury after surgery for Stanford type A acute aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(1): 67-72. doi: 10.7507/1007-4848.201804042 Copy

1.	生偉, 池一凡, 牛兆倬, 等. 急性 Stanford A 型主動脈夾層術后 ICU 監護時間延長的危險因素分析. 中國胸心血管外科臨床雜志, 2016, 23(5): 434-439.
2.	Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care, 2007, 11: R31.
3.	Palomba H, de Castro I, Neto AL et al. Acute kidney injury prediction following elective cardiac surgery: AKICS Score. Kidney Int, 2007, 72: 624-631.
4.	敬毅, 劉建平, 夏洪韜, 等. Stanford A 型主動脈夾層術后急性腎功能衰竭的救治分析. 中國醫藥指南, 2015, 13(20): 14-15.
5.	Wang X, Ren HM, Hu CY, et al. Predictors and in-hospital outcomes of preoperative acute kidney injury in patients with type A acute aortic dissection. J Geriatr Cardiol, 2016, 13(8): 679-684.
6.	Tribuddharat S, Sathitkarnmanee T, Ngamsaengsirisup K, et al. Validation of open-heart intraoperative risk score to predict a prolonged intensive care unit stay for adult patients undergoing cardiac surgery with cardiopulmonary bypass. Ther Clin Risk Manag, 2018, 14: 53-57.
7.	Moreira R, Jacinto T, Neves P, et al. Predictors of acute kidney injury in the postoperative period of cardiac surgery associated with cardiopulmonary bypass. Rev Port Cir Cardiotorac Vasc, 2017, 24(3-4): 154.
8.	Caputo M, Mokhtari A, Miceli A, et al. Controlled reoxygenation during cardiopulmonary bypass decreases markers of organ damage, inflammation, and oxidative stress in single-ventricle patients undergoing pediatric heart surgery. J Thorac Cardiovasc Surg, 2014, 148(3): 792-801.
9.	Korotcova L, Kumar S, Agematsu K, et al. Prolonged white matter inflammation after cardiopulmonary bypass and circulatory arrest in a juvenile porcine model. Ann Thorac Surg, 2015, 100(3): 1030-1037.
10.	Floh AA, Nakada M, La Rotta G, et al. Systemic inflammation increases energy expenditure following pediatric cardiopulmonary bypass. Pediatr Crit Care Med, 2015, 16(4): 343-351.
11.	Floh AA, Manlhiot C, Redington AN, et al. Insulin resistance and inflammation are a cause of hyperglycemia after pediatric cardiopulmonary bypass surgery. J Thorac Cardiovasc Surg, 2015, 150(3): 498-504.
12.	楊艷麗, 馬駿. 老年患者體外循環心臟手術后急性腎功能損傷及預后危險因素. 中國醫藥, 2017, 12(8): 1205-1208.
13.	文質斌, 崔曉光. 體外循環相關急性腎損傷的研究進展. 現代醫學, 2016, 44(1): 147-150.
14.	Del Porto F, di Gioia C, Tritapepe L, et al. The multitasking role of macrophages in Stanford type A acute aortic dissection. Cardiology, 2014, 127(2): 123-129.
15.	Anzai A, Shimoda M, Endo J, et al. Adventitial cxcl 1/g-csf expression in response to acute aortic dissection triggers local neutrophil recruitment and activation leading to aortic rupture. Circ Res, 2015, 116(4): 612-623.
16.	龐秀慧, 何亮, 社宇奎, 等. Stanford B 型主動脈夾層術前發生全身炎癥反應綜合征的多因素 Logistic 回歸分析. 國際外科學雜志, 2016, 43(6): 375-378.
17.	Takahashi T, Hasegawa T, Hirata N, et al. Impact of acute kidney injury on in-hospital outcomes in patients with DeBakey type Ⅲ acute aortic dissection. Am Cardiol, 2014, 113(11): 1904-1910.
18.	廖刃, 劉進. 圍手術期血液管理: 由限制性輸血走向個體化輸血. 中華醫學雜志, 2014, 94(7): 481-482.
19.	戴萍, 車輯, 張衛梅, 等. 心臟瓣膜置換術患者應用改良貯存式自體輸血和異體輸血的效果比較. 臨床輸血與檢驗, 2014, 16(2): 142-145.
20.	Moskowitz DM, McCullough JN, Shander A, et al. The impact of blood conservation on outcomes in cardiac surgery: is it safe and effective? Ann Thorac Surg, 2010, 90: 451-458.
21.	黃初生, 周慧, 覃家錦, 等. 白細胞濾過在體外循環中應用的 Meta 分析. 醫學信息, 2014, 27(5): 152-154.

1. 生偉, 池一凡, 牛兆倬, 等. 急性 Stanford A 型主動脈夾層術后 ICU 監護時間延長的危險因素分析. 中國胸心血管外科臨床雜志, 2016, 23(5): 434-439.
2. Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care, 2007, 11: R31.
3. Palomba H, de Castro I, Neto AL et al. Acute kidney injury prediction following elective cardiac surgery: AKICS Score. Kidney Int, 2007, 72: 624-631.
4. 敬毅, 劉建平, 夏洪韜, 等. Stanford A 型主動脈夾層術后急性腎功能衰竭的救治分析. 中國醫藥指南, 2015, 13(20): 14-15.
5. Wang X, Ren HM, Hu CY, et al. Predictors and in-hospital outcomes of preoperative acute kidney injury in patients with type A acute aortic dissection. J Geriatr Cardiol, 2016, 13(8): 679-684.
6. Tribuddharat S, Sathitkarnmanee T, Ngamsaengsirisup K, et al. Validation of open-heart intraoperative risk score to predict a prolonged intensive care unit stay for adult patients undergoing cardiac surgery with cardiopulmonary bypass. Ther Clin Risk Manag, 2018, 14: 53-57.
7. Moreira R, Jacinto T, Neves P, et al. Predictors of acute kidney injury in the postoperative period of cardiac surgery associated with cardiopulmonary bypass. Rev Port Cir Cardiotorac Vasc, 2017, 24(3-4): 154.
8. Caputo M, Mokhtari A, Miceli A, et al. Controlled reoxygenation during cardiopulmonary bypass decreases markers of organ damage, inflammation, and oxidative stress in single-ventricle patients undergoing pediatric heart surgery. J Thorac Cardiovasc Surg, 2014, 148(3): 792-801.
9. Korotcova L, Kumar S, Agematsu K, et al. Prolonged white matter inflammation after cardiopulmonary bypass and circulatory arrest in a juvenile porcine model. Ann Thorac Surg, 2015, 100(3): 1030-1037.
10. Floh AA, Nakada M, La Rotta G, et al. Systemic inflammation increases energy expenditure following pediatric cardiopulmonary bypass. Pediatr Crit Care Med, 2015, 16(4): 343-351.
11. Floh AA, Manlhiot C, Redington AN, et al. Insulin resistance and inflammation are a cause of hyperglycemia after pediatric cardiopulmonary bypass surgery. J Thorac Cardiovasc Surg, 2015, 150(3): 498-504.
12. 楊艷麗, 馬駿. 老年患者體外循環心臟手術后急性腎功能損傷及預后危險因素. 中國醫藥, 2017, 12(8): 1205-1208.
13. 文質斌, 崔曉光. 體外循環相關急性腎損傷的研究進展. 現代醫學, 2016, 44(1): 147-150.
14. Del Porto F, di Gioia C, Tritapepe L, et al. The multitasking role of macrophages in Stanford type A acute aortic dissection. Cardiology, 2014, 127(2): 123-129.
15. Anzai A, Shimoda M, Endo J, et al. Adventitial cxcl 1/g-csf expression in response to acute aortic dissection triggers local neutrophil recruitment and activation leading to aortic rupture. Circ Res, 2015, 116(4): 612-623.
16. 龐秀慧, 何亮, 社宇奎, 等. Stanford B 型主動脈夾層術前發生全身炎癥反應綜合征的多因素 Logistic 回歸分析. 國際外科學雜志, 2016, 43(6): 375-378.
17. Takahashi T, Hasegawa T, Hirata N, et al. Impact of acute kidney injury on in-hospital outcomes in patients with DeBakey type Ⅲ acute aortic dissection. Am Cardiol, 2014, 113(11): 1904-1910.
18. 廖刃, 劉進. 圍手術期血液管理: 由限制性輸血走向個體化輸血. 中華醫學雜志, 2014, 94(7): 481-482.
19. 戴萍, 車輯, 張衛梅, 等. 心臟瓣膜置換術患者應用改良貯存式自體輸血和異體輸血的效果比較. 臨床輸血與檢驗, 2014, 16(2): 142-145.
20. Moskowitz DM, McCullough JN, Shander A, et al. The impact of blood conservation on outcomes in cardiac surgery: is it safe and effective? Ann Thorac Surg, 2010, 90: 451-458.
21. 黃初生, 周慧, 覃家錦, 等. 白細胞濾過在體外循環中應用的 Meta 分析. 醫學信息, 2014, 27(5): 152-154.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Predictive risk factors for acute kidney injury after surgery for Stanford type A acute aortic dissection

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