Risk factors of acute kidney injury after surgery for acute type A aortic dissection: A systematic reveiw and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YU Jintian ¹ , CHEN Junshan ¹ ,  ZHANG Aiqin ²

1. Department of Intensive Care Unit, Jinling Hospital Affiliated to Medical College of Nanjing University (Eastern Theater General Hospital), Nanjing, 210002, P.R.China;
2. The Outpatient Department, Jinling Hospital Affiliated to Medical College of Nanjing University (Eastern Theater General Hospital), Nanjing, 210002, P.R.China;

Corresponding?author：

ZHANG Aiqin, Email: aq09z@126.com

Keywords：

Acute aortic dissection; acute kidney injury; risk factors; systematic review/meta-analysis

DOI：

10.7507/1007-4848.201903006

Video：

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Objective To systematically evaluate the risk factors of acute kidney injury after surgery for acute type A aortic dissection.Methods We searched the CNKI, Wanfang Database, VIP, PubMed, Web of science, Cochrane Library (from inception to January 2019) to identify studies about the risk factors of acute kidney injury after surgery for acute type A aortic dissection. Quality of the included studies was evaluated by Kars-Ottawa scale. The meta-analysis was performed by RevMan 5.3 software.Results A total of 16 case-control studies were included involving 1 728 patients. The results of meta-analysis showed that gender (OR=1.58, 95% CI 1.31 to 1.89, P<0.001), body mass index (OR=1.05, 95% CI 0.66 to 1.45, P<0.001), hypertension (OR=1.58, 95% CI 1.10 to 2.26, P=0.010), smoking history (OR=1.71, 95% CI 1.12 to 2.61, P=0.010), preoperative serum creatinine level (OR=30.26, 95% CI 20.17 to 40.35, P<0.000 01), preoperative white blood cell (OR=1.73, 95% CI 0.26 to 3.20, P=0.020), extracorporeal circulation time (OR=25.60, 95% CI 21.13 to 30.08, P<0.000 01), aortic occlusion time (OR=13.24, 95% CI 10.27 to 16.22, P<0.001), deep hypothermic circulatory arrest (DHCA) time (OR=2.58, 95% CI 0.86 to 4.29, P=0.003), arch replacement (OR=2.31, 95% CI 1.31 to 4.07, P=0.004), intraoperative blood transfusion (OR=1.27, 95% CI 0.29 to 2.24, P=0.010), postoperative mean arterial pressure (OR=–2.41, 95% CI –4.59 to –0.24, P=0.030), reoperation due to postoperative hemorrhage (OR=4.19, 95% CI 2.04 to 8.63, P<0.001), postoperative acute respiratory insufficiency (OR=6.61, 95% CI 3.21 to 13.60, P<0.001), postoperative mechanical ventilation time (OR=48.51, 95% CI 21.94 to 75.09, P<0.001) were associated with acute kidney injury after surgery for acute type A aortic dissection.Conclusion Current evidence shows that gender, body mass index, hypertension, smoking history, preoperative serum creatinine level, preoperative white blood cell, extracorporeal circulation time, aortic occlusion time, deep hypothermic circulatory arrest (DHCA) time, arch replacement, intraoperative blood transfusion, postoperative mean arterial pressure, postoperative hemorrhage reoperation, postoperative acute respiratory insufficiency and postoperative mechanical ventilation time were risk factors for acute kidney injury after surgery for type A aortic dissection. Medical staff can strengthen perioperative management of patients with acute type A aortic dissection combined with the above factors, so as to reduce the incidence of acute kidney injury after operation and improve the clinical prognosis of patients.

Citation： YU Jintian, CHEN Junshan, ZHANG Aiqin. Risk factors of acute kidney injury after surgery for acute type A aortic dissection: A systematic reveiw and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(1): 77-84. doi: 10.7507/1007-4848.201903006 Copy

1.	Baumann F, Makaloski V, Diehm N. Aortic aneurysms and aortic dissection: epidemiology, pathophysiology and diagnostics. Internist (Berl), 2013, 54(5): 535-542.
2.	Rylski B, Hoffmann I, Beyersdorf F, et al. Acute aortic dissection type A: age-related management and outcomes reported in the German Registry for Acute Aortic Dissection Type A (GERAADA) of over 2000 patients. Ann Surg, 2014, 259(3): 598-604.
3.	Kim W, Lee JH, Kim E, et al. Can we really predict postoperative acute kidney injury after aortic surgery? Diagnostic accuracy of risk scores using gray zone approach. Thorac Cardiovasc Surg, 2016, 64(4): 281-289.
4.	Zhao H, Pan X, Gong Z, et al. Risk factors for acute kidney injury in overweight patients with acute type A aortic dissection: a retrospective study. J Thorac Dis, 2015, 7(8): 1385-1390.
5.	Luo S, Ding H, Luo J, et al. Risk factors and early outcomes of acute renal injury after thoracic aortic endograft repair for type B aortic dissection. Ther Clin Risk Manag, 2017, 13: 1023-1029.
6.	Ko T, Higashitani M, Sato A, et al. Impact of acute kidney injury on early to long-term outcomes in patients who underwent surgery for type A acute aortic dissection. Am J Cardiol, 2015, 116(3): 463-468.
7.	Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury after thoracic aortic surgery for acute dissection. Ann Thorac Surg, 2012, 94(3): 766-771.
8.	Qiu Z, Chen L, Cao H, et al. Analysis of risk factors for acute kidney injury after ascending aortic replacement combined with open placement of triple-branched stent graft in type A aortic dissection: a new technique versus the traditional method in a single Chinese center. Med Sci Monit, 2015, 21: 674-680.
9.	Sansone F, Morgante A, Ceresa F, et al. Prognostic implications of acute renal failure after surgery for type A acute aortic dissection. Aorta (Stamford), 2015, 3(3): 91-97.
10.	尹廣, 陳欣. 急性腎損傷的定義及其臨床診斷新標準. 西部醫學, 2013, 25(12): 1916-1918.
11.	Sasabuchi Y, Kimura N, Shiotsuka J, et al. Long-term survival in patients with acute kidney injury after acute type a aortic dissection Repair. Ann Thorac Surg, 2016, 102(6): 2003-2009.
12.	Wu HB, Qin H, Ma WG, et al. Can renal resistive index predict acute kidney injury after acute type A aortic dissection repair. Ann Thorac Surg, 2017, 104(5): 1583-1589.
13.	Qin H, Wu H, Chen Y, et al. Early Detection of postoperative acute kidney injury in acute stanford type A aortic dissection with doppler renal resistive index. J Ultrasound Med, 2017, 36(10): 2105-2111.
14.	宋先榮, 韓雪萍. Stanford A型主動脈夾層術后急性腎損傷的影響因素. 中華胸心血管外科雜志, 2012, 28(10): 603-604, 613.
15.	王樹偉, 蘇存華, 閻巖, 等. 急性A型主動脈夾層術后腎衰竭的危險因素分析. 第二軍醫大學學報, 2014, 35(2): 136-140.
16.	曾嶸, 范瑞新, 范小平, 等. 急性A型主動脈夾層患者術后急性腎損傷的危險因素. 中華胸心血管外科雜志, 2014, 30(1): 30-32, 37.
17.	阮彩霞, 尚蔚, 侯曉彤, 等. C反應蛋白與急性A型主動脈夾層術后急性腎損傷的相關性. 中華胸心血管外科雜志, 2014, 30(12): 741-744.
18.	尚蔚, 馬敏, 阮彩霞, 等. 急性主動脈夾層孫氏手術后急性腎損傷臨床研究. 中華胸心血管外科雜志, 2016, 32(7): 407-410.
19.	潘旭東, 趙宏磊, 白濤, 等. 超重急性A型主動脈夾層患者孫氏術后急性腎損傷的危險因素分析. 中華胸心血管外科雜志, 2017, 33(5): 295-299.
20.	石海鵬, 王秀哲, 楊曉靜, 等. 急性Stanford A型主動脈夾層患者術后并發急性腎損傷危險因素的回顧性研究. 中華重癥醫學電子雜志(網絡版), 2017, 3(4): 275-279.
21.	生偉, 欒天, 池一凡, 等. 急性Stanford A型主動脈夾層術后急性腎功能損傷的危險因素分析. 中國胸心血管外科臨床雜志, 2019, 26(1): 67-72.
22.	貢鳴, 李磊, 李嘉晨, 等. 急性A型主動脈夾層患者腎損傷與超重的相關性研究. 心肺血管病雜志, 2019, 38(1): 30-35, 51.
23.	葉楠, 張燕, 程虹, 等. 成人心外科手術后急性腎損傷的評分預警系統創建. 中國胸心血管外科臨床雜志, 2013, 20(4): 396-401.
24.	劉洋, 嚴中亞. 二尖瓣主動脈瓣雙瓣置換術后急性腎損傷發生的相關危險因素分析. 中華臨床醫師雜志(電子版), 2015, 9(11): 2127-2130.
25.	Hodeify R, Megyesi J, Tarcsafalvi A, et al. Gender differences control the susceptibility to ER stress-induced acute kidney injury. Am J Physiol Renal Physiol, 2013, 304(7): F875-F882.
26.	Sullivan KE, Byrne JS, Hudson A, et a1. The effect of obesity on acute kidney injury after cardiac surgery. J Thorac Cardiovase Surg, 2015, 150(6): 1622-1628.
27.	韋莉萍. 成年人體外循環心臟手術后急性腎損傷相關危險因素分析. 廣西: 廣西醫科大學, 2017.
28.	Kim WH, Park MH, Kim HJ, et al. Potentially modifiable risk factors for acute kidney injury after surgery on the thoracic aorta: a propensity score matched case-control study. Medicine (Baltimore), 2015, 94(2): 273-281.
29.	Ejerblad E, Fored CM, Lindblad P, et al. Association between smoking and chronic renal failure in a nationwide population-based case-control study. J Am Soc Nephrol, 2004, 15(8): 2178-2185.
30.	王肇, 高長青, 肖蒼松, 等. 主動脈夾層術后早期急性腎損傷的危險因素分析. 解放軍醫學院學報, 2014, 35(7): 692-695.
31.	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 J Cardiol, 2014, 113(11): 1904-1910.
32.	Kuehl H, Eggebrecht H, Boes T, et al. Detection of inflammation in patients with acute aortic syndrome: comparison of FDG-PET/CT imaging and serological markers of inflammation. Heart, 2008, 94(11): 1472-1477.
33.	Wojtaszek E, G?ogowski T. Cardiac surgery associated acute kidney injury. Wiad Lek, 2015, 68(4 Pt 2): 668-670.
34.	Bonventre JV, Yang L. Cellular pathophysiology of ischemic acute kidney injury. J Clin Invest, 2011, 121(11): 4210-4221.
35.	陳玉新. 心臟直視手術圍術期急性腎損傷影響因素分析. 河南: 鄭州大學, 2017.
36.	Nuis RJ, Rodes CJ, Sinning JM, et al. Blood transfusion and the risk of acute kidney injury after transcatheter aortic valve implantation. Circ Cardiovasc Interv, 2012, 5(5): 680-688.
37.	Karkouti K. Transfusion and risk of acute kidney injury in cardiae surgery. Br J Anaesth, 2012, 109(Suppl l): i29-i38.
38.	萬辛, 陳鑫, 謝祥成, 等. 心臟手術相關性急性腎損傷發病率及其危險因素分析. 南京醫科大學學報(自然科學版), 2015, 35(12): 1746-1749.
39.	Fischer UM, Weissenberger WK, Warters RD, et al. Impact of cardio pulmonary bypass management on postcardiac surgery renal function. Perfusion, 2002, 17(6): 401-406.
40.	Petek BJ, Bravo PE, Kim F, et al. Incidence and risk factors for postcontrast acute kidney injury in survivors of sudden cardiac arrest. Ann Emerg Med, 2016, 67(4): 469-476.
41.	Karkouti K, Wijeysundera DN, Yau TM, et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation, 2009, 119(4): 495-502.
42.	Wang Y, Xue S, Zhu H. Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery. J Cardiothorac Surg, 2013, 8: 118-123.
43.	van den Akker JP, Egal M, Groeneveld AB. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysis. Crit Care, 2013, 17(3): R98-R107.

1. Baumann F, Makaloski V, Diehm N. Aortic aneurysms and aortic dissection: epidemiology, pathophysiology and diagnostics. Internist (Berl), 2013, 54(5): 535-542.
2. Rylski B, Hoffmann I, Beyersdorf F, et al. Acute aortic dissection type A: age-related management and outcomes reported in the German Registry for Acute Aortic Dissection Type A (GERAADA) of over 2000 patients. Ann Surg, 2014, 259(3): 598-604.
3. Kim W, Lee JH, Kim E, et al. Can we really predict postoperative acute kidney injury after aortic surgery? Diagnostic accuracy of risk scores using gray zone approach. Thorac Cardiovasc Surg, 2016, 64(4): 281-289.
4. Zhao H, Pan X, Gong Z, et al. Risk factors for acute kidney injury in overweight patients with acute type A aortic dissection: a retrospective study. J Thorac Dis, 2015, 7(8): 1385-1390.
5. Luo S, Ding H, Luo J, et al. Risk factors and early outcomes of acute renal injury after thoracic aortic endograft repair for type B aortic dissection. Ther Clin Risk Manag, 2017, 13: 1023-1029.
6. Ko T, Higashitani M, Sato A, et al. Impact of acute kidney injury on early to long-term outcomes in patients who underwent surgery for type A acute aortic dissection. Am J Cardiol, 2015, 116(3): 463-468.
7. Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury after thoracic aortic surgery for acute dissection. Ann Thorac Surg, 2012, 94(3): 766-771.
8. Qiu Z, Chen L, Cao H, et al. Analysis of risk factors for acute kidney injury after ascending aortic replacement combined with open placement of triple-branched stent graft in type A aortic dissection: a new technique versus the traditional method in a single Chinese center. Med Sci Monit, 2015, 21: 674-680.
9. Sansone F, Morgante A, Ceresa F, et al. Prognostic implications of acute renal failure after surgery for type A acute aortic dissection. Aorta (Stamford), 2015, 3(3): 91-97.
10. 尹廣, 陳欣. 急性腎損傷的定義及其臨床診斷新標準. 西部醫學, 2013, 25(12): 1916-1918.
11. Sasabuchi Y, Kimura N, Shiotsuka J, et al. Long-term survival in patients with acute kidney injury after acute type a aortic dissection Repair. Ann Thorac Surg, 2016, 102(6): 2003-2009.
12. Wu HB, Qin H, Ma WG, et al. Can renal resistive index predict acute kidney injury after acute type A aortic dissection repair. Ann Thorac Surg, 2017, 104(5): 1583-1589.
13. Qin H, Wu H, Chen Y, et al. Early Detection of postoperative acute kidney injury in acute stanford type A aortic dissection with doppler renal resistive index. J Ultrasound Med, 2017, 36(10): 2105-2111.
14. 宋先榮, 韓雪萍. Stanford A型主動脈夾層術后急性腎損傷的影響因素. 中華胸心血管外科雜志, 2012, 28(10): 603-604, 613.
15. 王樹偉, 蘇存華, 閻巖, 等. 急性A型主動脈夾層術后腎衰竭的危險因素分析. 第二軍醫大學學報, 2014, 35(2): 136-140.
16. 曾嶸, 范瑞新, 范小平, 等. 急性A型主動脈夾層患者術后急性腎損傷的危險因素. 中華胸心血管外科雜志, 2014, 30(1): 30-32, 37.
17. 阮彩霞, 尚蔚, 侯曉彤, 等. C反應蛋白與急性A型主動脈夾層術后急性腎損傷的相關性. 中華胸心血管外科雜志, 2014, 30(12): 741-744.
18. 尚蔚, 馬敏, 阮彩霞, 等. 急性主動脈夾層孫氏手術后急性腎損傷臨床研究. 中華胸心血管外科雜志, 2016, 32(7): 407-410.
19. 潘旭東, 趙宏磊, 白濤, 等. 超重急性A型主動脈夾層患者孫氏術后急性腎損傷的危險因素分析. 中華胸心血管外科雜志, 2017, 33(5): 295-299.
20. 石海鵬, 王秀哲, 楊曉靜, 等. 急性Stanford A型主動脈夾層患者術后并發急性腎損傷危險因素的回顧性研究. 中華重癥醫學電子雜志(網絡版), 2017, 3(4): 275-279.
21. 生偉, 欒天, 池一凡, 等. 急性Stanford A型主動脈夾層術后急性腎功能損傷的危險因素分析. 中國胸心血管外科臨床雜志, 2019, 26(1): 67-72.
22. 貢鳴, 李磊, 李嘉晨, 等. 急性A型主動脈夾層患者腎損傷與超重的相關性研究. 心肺血管病雜志, 2019, 38(1): 30-35, 51.
23. 葉楠, 張燕, 程虹, 等. 成人心外科手術后急性腎損傷的評分預警系統創建. 中國胸心血管外科臨床雜志, 2013, 20(4): 396-401.
24. 劉洋, 嚴中亞. 二尖瓣主動脈瓣雙瓣置換術后急性腎損傷發生的相關危險因素分析. 中華臨床醫師雜志(電子版), 2015, 9(11): 2127-2130.
25. Hodeify R, Megyesi J, Tarcsafalvi A, et al. Gender differences control the susceptibility to ER stress-induced acute kidney injury. Am J Physiol Renal Physiol, 2013, 304(7): F875-F882.
26. Sullivan KE, Byrne JS, Hudson A, et a1. The effect of obesity on acute kidney injury after cardiac surgery. J Thorac Cardiovase Surg, 2015, 150(6): 1622-1628.
27. 韋莉萍. 成年人體外循環心臟手術后急性腎損傷相關危險因素分析. 廣西: 廣西醫科大學, 2017.
28. Kim WH, Park MH, Kim HJ, et al. Potentially modifiable risk factors for acute kidney injury after surgery on the thoracic aorta: a propensity score matched case-control study. Medicine (Baltimore), 2015, 94(2): 273-281.
29. Ejerblad E, Fored CM, Lindblad P, et al. Association between smoking and chronic renal failure in a nationwide population-based case-control study. J Am Soc Nephrol, 2004, 15(8): 2178-2185.
30. 王肇, 高長青, 肖蒼松, 等. 主動脈夾層術后早期急性腎損傷的危險因素分析. 解放軍醫學院學報, 2014, 35(7): 692-695.
31. 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 J Cardiol, 2014, 113(11): 1904-1910.
32. Kuehl H, Eggebrecht H, Boes T, et al. Detection of inflammation in patients with acute aortic syndrome: comparison of FDG-PET/CT imaging and serological markers of inflammation. Heart, 2008, 94(11): 1472-1477.
33. Wojtaszek E, G?ogowski T. Cardiac surgery associated acute kidney injury. Wiad Lek, 2015, 68(4 Pt 2): 668-670.
34. Bonventre JV, Yang L. Cellular pathophysiology of ischemic acute kidney injury. J Clin Invest, 2011, 121(11): 4210-4221.
35. 陳玉新. 心臟直視手術圍術期急性腎損傷影響因素分析. 河南: 鄭州大學, 2017.
36. Nuis RJ, Rodes CJ, Sinning JM, et al. Blood transfusion and the risk of acute kidney injury after transcatheter aortic valve implantation. Circ Cardiovasc Interv, 2012, 5(5): 680-688.
37. Karkouti K. Transfusion and risk of acute kidney injury in cardiae surgery. Br J Anaesth, 2012, 109(Suppl l): i29-i38.
38. 萬辛, 陳鑫, 謝祥成, 等. 心臟手術相關性急性腎損傷發病率及其危險因素分析. 南京醫科大學學報(自然科學版), 2015, 35(12): 1746-1749.
39. Fischer UM, Weissenberger WK, Warters RD, et al. Impact of cardio pulmonary bypass management on postcardiac surgery renal function. Perfusion, 2002, 17(6): 401-406.
40. Petek BJ, Bravo PE, Kim F, et al. Incidence and risk factors for postcontrast acute kidney injury in survivors of sudden cardiac arrest. Ann Emerg Med, 2016, 67(4): 469-476.
41. Karkouti K, Wijeysundera DN, Yau TM, et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation, 2009, 119(4): 495-502.
42. Wang Y, Xue S, Zhu H. Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery. J Cardiothorac Surg, 2013, 8: 118-123.
43. van den Akker JP, Egal M, Groeneveld AB. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysis. Crit Care, 2013, 17(3): R98-R107.

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Risk factors of acute kidney injury after surgery for acute type A aortic dissection: A systematic reveiw and meta-analysis

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