Ko Toshiyuki, Higashitani Michiaki, Sato Akihiko, Uemura Yukari, Norimatsu Togo, Mahara Keitaro, Takamisawa Itaru, Seki Atsushi, Shimizu Jun, Tobaru Tetsuya, Aramoto Haruo, Iguchi Nobuo, Fukui Toshihiro, Watanabe Masafumi, Nagayama Masatoshi, Takayama Morimasa, Takanashi Shuichiro, Sumiyoshi Tetsuya, Komuro Issei, Tomoike Hitonobu
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
Am J Cardiol. 2015 Aug 1;116(3):463-8. doi: 10.1016/j.amjcard.2015.04.043. Epub 2015 May 8.
Acute kidney injury (AKI) is relatively common after cardiothoracic surgery for type A acute aortic dissection (TA-AAD) and increases mortality. We investigated the incidence and risk factors for AKI in patients with TA-AAD and its impact on their outcomes. The records of 375 consecutive patients who underwent surgical treatment for TA-AAD from October 2007 to March 2013 were analyzed retrospectively. We defined AKI using the Kidney Disease Improving Global Outcomes criteria, which are based on serum creatinine concentration or glomerular filtration rate. We used Kaplan-Meier methods and multivariate Cox proportional hazards regression to assess the impact of AKI on both mortality and major adverse cardiovascular and cerebrovascular events. We also examined the association between risk factors and AKI using logistic regression modeling. Postoperative AKI was observed in 165 patients (44.0%). The overall 30-day and mid- to long-term mortality was 1.6% and 8.8%, respectively. Mortality and major adverse cardiovascular and cerebrovascular events correlated significantly with the severity of AKI, and multivariate analysis showed that AKI stage 3 (the most sever stage) was an independent risk factor for mortality (hazard ratio 6.83, 95% confidence interval 2.52 to 18.52) after adjustment for important confounding factors. Extracorporeal circulation time, body mass index, perioperative peak serum C-reactive protein concentration, renal malperfusion, and perioperative sepsis were found to be risk factors for AKI. In conclusion, AKI was common in patients who underwent surgery for type A acute aortic dissection. The severity of AKI strongly influences patient outcomes, so it should be recognized promptly and treated aggressively when possible.
急性肾损伤（AKI）在A型急性主动脉夹层（TA-AAD）的心胸外科手术后相对常见，且会增加死亡率。我们调查了TA-AAD患者中AKI的发生率、危险因素及其对患者预后的影响。回顾性分析了2007年10月至2013年3月期间连续375例接受TA-AAD手术治疗患者的病历。我们根据基于血清肌酐浓度或肾小球滤过率的改善全球肾脏病预后组织（KDIGO）标准来定义AKI。我们使用Kaplan-Meier方法和多变量Cox比例风险回归来评估AKI对死亡率和主要不良心血管和脑血管事件的影响。我们还使用逻辑回归模型研究了危险因素与AKI之间的关联。165例患者（44.0%）术后发生AKI。总体30天和中长期死亡率分别为1.6%和8.8%。死亡率和主要不良心血管和脑血管事件与AKI的严重程度显著相关，多变量分析显示，在调整重要混杂因素后，AKI 3期（最严重阶段）是死亡率的独立危险因素（风险比6.83，95%置信区间2.52至18.52）。体外循环时间、体重指数、围手术期血清C反应蛋白峰值浓度、肾灌注不良和围手术期脓毒症被发现是AKI的危险因素。总之，AKI在接受A型急性主动脉夹层手术的患者中很常见。AKI的严重程度强烈影响患者预后，因此应尽早识别并尽可能积极治疗。
