Incidence of postoperative acute kidney injury and risk factors for prognosis in patients with acute Stanford type A aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHENG Wei ¹ , WANG Zhenbao ² , NIU Zhaozhuo ² , ZHANG Wenfeng ² , WU Jiantao ² , WANG Tianyi ² , LI Haoyou ² , WANG Jixian ² ,  YANG Haiqin ³

1. Department of Cardiovascular Surgery, Qingdao Hiser Hospital Affiliated of Qingdao University, Qingdao, 266033, Shandong, P. R. China;
2. Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, 266071, Shandong, P. R. China;
3. Department of Mental Intervention, Qingdao Preferential Hospital, Qingdao, 266071, Shandong, P. R. China;

Corresponding?author：

YANG Haiqin, Email: rose8118@126.com

Keywords：

Acute Stanford type A aortic dissection; acute kidney injury; risk factors; prognosis

DOI：

10.7507/1007-4848.202210094

Video：

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Objective To investigate the prognosis and impact of postoperative acute kidney injury (AKI) on patients with acute Stanford type A aortic dissection (ATAAD), and to analyze the predictors for short- and medium-term survival. Methods Clinical data of patients who underwent ATAAD surgery in Qingdao Municipal Hospital from May 2014 to May 2019 were retrospectively analyzed. All discharged patients underwent telephone or outpatient follow-up, and were divided into an AKI group and a non-AKI group based on whether AKI occurred after surgery. The impact of postoperative AKI on the short- and medium-term prognosis was analyzed, and multivariate Cox analysis was used to screen the risk factors for short- and medium-term mortality. Results A total of 192 patients were collected, including 139 males and 53 females, with an average age of 53.3±11.4 years. Postoperative AKI was identified in 43 (22.4%) patients. The average follow-up time of discharged patients was 23.4±2.4 months, and the lost rate was 5.1%. The two-year survival rate after discharge of the AKI group was 88.2%, and that of the non-AKI group was 97.2%. Kaplan-Meier survival analysis and log-rank test showed that there was a statistical difference between the two groups (χ²=5.355, log-rank P=0.021). Multivariate Cox analysis results showed that age (HR=1.070, 95%CI 1.026 to 1.116, P=0.002), cardiopulmonary bypass time (HR=1.026, 95%CI 1.003 to 1.050, P=0.026), postoperative AKI (HR=3.681, 95%CI 1.579 to 8.582, P=0.003), transfusion volume of red blood cell intraoperatively and within 24 hours postoperatively (HR=1.548, 95%CI 1.183 to 2.026, P=0.001) were independent risk factors for the short- and medium-term mortality of ATAAD patients. Conclusion The incidence of postoperative AKI is high in ATAAD patients, and the mortality of patients with AKI increases significantly within two years. Age, cardiopulmonary bypass time and transfusion volume of red blood cell intraoperatively and within 24 hours postoperatively are also independent risk factors for short- and medium-term prognosis.

Citation： SHENG Wei, WANG Zhenbao, NIU Zhaozhuo, ZHANG Wenfeng, WU Jiantao, WANG Tianyi, LI Haoyou, WANG Jixian, YANG Haiqin. Incidence of postoperative acute kidney injury and risk factors for prognosis in patients with acute Stanford type A aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(12): 1725-1730. doi: 10.7507/1007-4848.202210094 Copy

1.	Zhang K, Shang J, Chen Y, et al. The prognosis and risk factors for acute kidney injury in high-risk patients after surgery for type A aortic dissection in the ICU. J Thorac Dis, 2021, 13(7): 4427-4437.
2.	Li L, Zhou J, Hao X, et al. The incidence, risk factors and in-hospital mortality of acute kidney injury in patients after surgery for acute type A aortic dissection: A single-center retrospective analysis of 335 patients. Front Med (Lausanne), 2020, 7: 557044.
3.	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.
4.	Kim WH, 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.
5.	Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract, 2012, 120(4): c179-c184.
6.	Yu Y, Lyu Y, Jin L, et al. Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring. Brain Behav, 2019, 9(7): e01309.
7.	Norton EL, Khaja MS, Williams DM, et al. Type A aortic dissection complicated by malperfusion syndrome. Curr Opin Cardiol, 2019, 34(6): 610-615.
8.	焦瑞, 劉楠. 急性StanfordA型主動脈夾層術后急性腎損傷患者連續性腎臟替代治療后的死亡預后因素分析. 中華外科雜志, 2017, 55(4): 270-273.
9.	Helgason D, Helgadottir S, Ahlsson A, et al. Acute kidney injury after acute repair of type A aortic dissection. Ann Thorac Surg, 2021, 111(4): 1292-1298.
10.	Nakamura T, Mikamo A, Matsuno Y, et al. Impact of acute kidney injury on prognosis of chronic kidney disease after aortic arch surgery. Interact Cardiovasc Thorac Surg, 2020, 30(2): 273-279.
11.	Tsai HS, Tsai FC, Chen YC, et al. Impact of acute kidney injury on one-year survival after surgery for aortic dissection. Ann Thorac Surg, 2012, 94(5): 1407-1412.
12.	中國心臟重癥連續性腎臟替代治療專家共識工作組. 心臟外科圍手術期連續性腎臟替代治療專家共識. 中華醫學雜志, 2019, 99(5): 321-328.
13.	顧嘉璽, 邵永豐, 倪布清, 等. 急性Stanford A型主動脈夾層孫氏手術后院內死亡危險因素分析. 南京醫科大學學報(自然科學版), 2020, 40(8): 1194-1197.
14.	Conzelmann LO, Weigang E, Mehlhorn U, et al. Mortality in patients with acute aortic dissection type A: Analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg, 2016, 49(2): e44-e52.
15.	楊志剛, 羅進光. 急性Stanford A型主動脈夾層術后早期死亡危險因素及nomogram模型構建. 中國循證心血管醫學雜志, 2021, 13(7): 799-802.
16.	Jussli-Melchers J, Panholzer B, Friedrich C, et al. Long-term outcome and quality of life following emergency surgery for acute aortic dissection type A: A comparison between young and elderly adults. Eur J Cardiothorac Surg, 2017, 51(3): 465-471.
17.	Wang Z, Ge M, Chen T, et al. Risk factors and long-term outcomes of elderly patients complicating with acute kidney injury after type A acute aortic dissection surgery: A retrospective study. J Thorac Dis, 2020, 12(10): 5833-5841.
18.	Xu S, Liu J, Li L, et al. Cardiopulmonary bypass time is an independent risk factor for acute kidney injury in emergent thoracic aortic surgery: A retrospective cohort study. J Cardiothorac Surg, 2019, 14(1): 90.
19.	Ge H, Jiang Y, Jin Q, et al. Nomogram for the prediction of postoperative hypoxemia in patients with acute aortic dissection. BMC Anesthesiol, 2018, 18(1): 146.
20.	Zhang K, Pan XD, Dong SB, et al. Cardiopulmonary bypass duration is an independent predictor of adverse outcome in surgical repair for acute type A aortic dissection. J Int Med Res, 2020, 48(11): 300060520968450.
21.	Vlot EA, Verwijmeren L, van de Garde EMW, et al. Intra-operative red blood cell transfusion and mortality after cardiac surgery. BMC Anesthesiol, 2019, 19(1): 65.
22.	Garg AX, Badner N, Bagshaw SM, et al. Safety of a restrictive versus liberal approach to red blood cell transfusion on the outcome of AKI in patients undergoing cardiac surgery: A randomized clinical trial. J Am Soc Nephrol, 2019, 30(7): 1294-1304.

1. Zhang K, Shang J, Chen Y, et al. The prognosis and risk factors for acute kidney injury in high-risk patients after surgery for type A aortic dissection in the ICU. J Thorac Dis, 2021, 13(7): 4427-4437.
2. Li L, Zhou J, Hao X, et al. The incidence, risk factors and in-hospital mortality of acute kidney injury in patients after surgery for acute type A aortic dissection: A single-center retrospective analysis of 335 patients. Front Med (Lausanne), 2020, 7: 557044.
3. 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.
4. Kim WH, 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.
5. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract, 2012, 120(4): c179-c184.
6. Yu Y, Lyu Y, Jin L, et al. Prognostic factors for permanent neurological dysfunction after total aortic arch replacement with regional cerebral oxygen saturation monitoring. Brain Behav, 2019, 9(7): e01309.
7. Norton EL, Khaja MS, Williams DM, et al. Type A aortic dissection complicated by malperfusion syndrome. Curr Opin Cardiol, 2019, 34(6): 610-615.
8. 焦瑞, 劉楠. 急性StanfordA型主動脈夾層術后急性腎損傷患者連續性腎臟替代治療后的死亡預后因素分析. 中華外科雜志, 2017, 55(4): 270-273.
9. Helgason D, Helgadottir S, Ahlsson A, et al. Acute kidney injury after acute repair of type A aortic dissection. Ann Thorac Surg, 2021, 111(4): 1292-1298.
10. Nakamura T, Mikamo A, Matsuno Y, et al. Impact of acute kidney injury on prognosis of chronic kidney disease after aortic arch surgery. Interact Cardiovasc Thorac Surg, 2020, 30(2): 273-279.
11. Tsai HS, Tsai FC, Chen YC, et al. Impact of acute kidney injury on one-year survival after surgery for aortic dissection. Ann Thorac Surg, 2012, 94(5): 1407-1412.
12. 中國心臟重癥連續性腎臟替代治療專家共識工作組. 心臟外科圍手術期連續性腎臟替代治療專家共識. 中華醫學雜志, 2019, 99(5): 321-328.
13. 顧嘉璽, 邵永豐, 倪布清, 等. 急性Stanford A型主動脈夾層孫氏手術后院內死亡危險因素分析. 南京醫科大學學報(自然科學版), 2020, 40(8): 1194-1197.
14. Conzelmann LO, Weigang E, Mehlhorn U, et al. Mortality in patients with acute aortic dissection type A: Analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg, 2016, 49(2): e44-e52.
15. 楊志剛, 羅進光. 急性Stanford A型主動脈夾層術后早期死亡危險因素及nomogram模型構建. 中國循證心血管醫學雜志, 2021, 13(7): 799-802.
16. Jussli-Melchers J, Panholzer B, Friedrich C, et al. Long-term outcome and quality of life following emergency surgery for acute aortic dissection type A: A comparison between young and elderly adults. Eur J Cardiothorac Surg, 2017, 51(3): 465-471.
17. Wang Z, Ge M, Chen T, et al. Risk factors and long-term outcomes of elderly patients complicating with acute kidney injury after type A acute aortic dissection surgery: A retrospective study. J Thorac Dis, 2020, 12(10): 5833-5841.
18. Xu S, Liu J, Li L, et al. Cardiopulmonary bypass time is an independent risk factor for acute kidney injury in emergent thoracic aortic surgery: A retrospective cohort study. J Cardiothorac Surg, 2019, 14(1): 90.
19. Ge H, Jiang Y, Jin Q, et al. Nomogram for the prediction of postoperative hypoxemia in patients with acute aortic dissection. BMC Anesthesiol, 2018, 18(1): 146.
20. Zhang K, Pan XD, Dong SB, et al. Cardiopulmonary bypass duration is an independent predictor of adverse outcome in surgical repair for acute type A aortic dissection. J Int Med Res, 2020, 48(11): 300060520968450.
21. Vlot EA, Verwijmeren L, van de Garde EMW, et al. Intra-operative red blood cell transfusion and mortality after cardiac surgery. BMC Anesthesiol, 2019, 19(1): 65.
22. Garg AX, Badner N, Bagshaw SM, et al. Safety of a restrictive versus liberal approach to red blood cell transfusion on the outcome of AKI in patients undergoing cardiac surgery: A randomized clinical trial. J Am Soc Nephrol, 2019, 30(7): 1294-1304.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Incidence of postoperative acute kidney injury and risk factors for prognosis in patients with acute Stanford type A aortic dissection

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