Fan Pei-Yi, Chen Chao-Yu, Lee Cheng-Chia, Liu Kuo-Sheng, Wu Victor Chien-Chia, Fan Pei-Chun, Chang Ming-Yang, Chang Jason Chih-Hsiang, Tian Ya-Chung, Chen Shao-Wei
Kidney Research Center, Department of Critical Care Nephrology, Division of Nephrology, Chang Gung Memorial Hospital, Linkou Branch.
Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University.
Medicine (Baltimore). 2019 May;98(20):e15453. doi: 10.1097/MD.0000000000015453.
Preoperative renal dysfunction is associated with mortality in patients who undergo coronary artery bypass graft and valve surgery. However, the role of preoperative renal dysfunction in type A aortic dissection (TAAD) remains unclear. This study aimed to evaluate the impact of preoperative renal dysfunction on the outcome of surgical intervention in patients with TAAD.We retrospectively studied the outcomes of 159 patients with TAAD who were treated at a tertiary referral hospital between 2005 and 2010. The demographics and surgical details of patients were analyzed according to their renal function. Risk factors for outcomes were analyzed using multivariable logistic regression. Thirty-two of the patients (20.1%) had preoperative serum creatinine of 1.5 mg/dL or more. The multivariable logistic regression model revealed independent risk factors of in-hospital mortality to be renal dysfunction (odds ratio [OR], 3.79; 95% confidence interval [CI], 1.64-8.77), preoperative shock (OR, 8.75; 95% CI, 2.83-27.02), and bypass time (OR, 1.008; 95% CI, 1.003-1.013). In addition, patients with renal dysfunction exhibited a lower 90-day survival rate than did patients without the condition (P of log-rank test = .005).Preoperative renal dysfunction may have a critical role in the surgical outcomes of patients with TAAD. Additional large-scale investigations are warranted.
术前肾功能不全与接受冠状动脉搭桥术和瓣膜手术患者的死亡率相关。然而，术前肾功能不全在A型主动脉夹层（TAAD）中的作用仍不清楚。本研究旨在评估术前肾功能不全对TAAD患者手术干预结局的影响。我们回顾性研究了2005年至2010年间在一家三级转诊医院接受治疗的159例TAAD患者的结局。根据患者的肾功能分析其人口统计学和手术细节。使用多变量逻辑回归分析结局的危险因素。32例患者（20.1%）术前血清肌酐为1.5mg/dL或更高。多变量逻辑回归模型显示，院内死亡的独立危险因素为肾功能不全（比值比[OR]，3.79；95%置信区间[CI]，1.64 - 8.77）、术前休克（OR，8.75；95%CI，2.83 - 27.02）和体外循环时间（OR，1.008；95%CI，1.003 - 1.013）。此外，肾功能不全患者的90天生存率低于无肾功能不全的患者（对数秩检验P = 0.005）。术前肾功能不全可能在TAAD患者的手术结局中起关键作用。有必要进行更多大规模研究。
