Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Interact Cardiovasc Thorac Surg. 2020 Nov 1;31(5):697-703. doi: 10.1093/icvts/ivaa164.
Acute kidney injury (AKI) is a relatively common complication after an operation for type A acute aortic dissection and is indicative of a poor prognosis. We examined the risk factors for and the outcomes of developing AKI in patients being operated on for thoracic aortic diseases.
We retrospectively analysed 712 patients with acute type A dissection who had deep hypothermic circulatory operations from January 2014 to December 2018, emphasizing those who developed AKI. Logistic regression models were used to identify predisposing factors for the postoperative development of AKI.
Among all enrolled patients, 359 (50.4%) had AKI; of these, 133 were diagnosed as stage 1 (18.7%), 126 were stage 2 (17.7%) and 100 were stage 3 (14.0%). Postoperative haemodialysis was required in 111 patients (15.9%). The development of AKI after aortic surgery contributed to the higher mortality rate within 30 days after surgery (P < 0.001), longer stay in the intensive care unit (P = 0.01) and longer hospital stay (P < 0.001). Binary logistic regression analysis showed that preoperative cystatin C levels [odds ratio (OR) 2.615, 95% confidence interval (CI) 1.139-6.002; P = 0.023] and postoperative ventilation time (OR 1.019, 95% CI 1.005-1.034; P = 0.009) were independent risk factors for developing AKI. Multiple ordinal logistic regression analyses showed that the preoperative cystatin C level (OR 2.921, 95% CI 1.542-5.540; P = 0.001) was an independent risk factor associated with the severity of AKI.
Our data suggested that the development of AKI after surgery for type A acute aortic dissection was common and associated with an increased short-term mortality rate. The preoperative cystatin C level was identified as an indicator for the occurrence and severity of AKI postoperatively. Furthermore, we discovered that longer postoperative ventilation time was also associated with the development of AKI.
急性肾损伤（AKI）是急性 A 型主动脉夹层手术后较为常见的并发症，提示预后不良。本研究旨在探讨胸主动脉疾病患者术后 AKI 的发生风险因素及结局。
回顾性分析 2014 年 1 月至 2018 年 12 月期间行深低温体外循环手术的急性 A 型主动脉夹层患者 712 例，重点分析术后发生 AKI 的患者。采用 logistic 回归模型分析术后发生 AKI 的易患因素。
所有入组患者中，359 例（50.4%）发生 AKI，其中 133 例为 1 期（18.7%），126 例为 2 期（17.7%），100 例为 3 期（14.0%）。111 例（15.9%）患者术后需要行血液透析。主动脉手术后发生 AKI 与术后 30 天内死亡率较高（P<0.001）、入住重症监护病房时间较长（P=0.01）和住院时间较长（P<0.001）相关。二元逻辑回归分析显示，术前胱抑素 C 水平（比值比 2.615，95%置信区间 1.139-6.002；P=0.023）和术后通气时间（比值比 1.019，95%置信区间 1.005-1.034；P=0.009）是发生 AKI 的独立危险因素。多序逻辑回归分析显示，术前胱抑素 C 水平（比值比 2.921，95%置信区间 1.542-5.540；P=0.001）是与 AKI 严重程度相关的独立危险因素。
本研究数据表明，急性 A 型主动脉夹层手术后 AKI 的发生较为常见，与短期死亡率增加相关。术前胱抑素 C 水平是术后发生 AKI 的指标之一，此外，我们发现术后通气时间延长也与 AKI 的发生有关。
