Internal Medicine Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
Ann Thorac Surg. 2021 Apr;111(4):1292-1298. doi: 10.1016/j.athoracsur.2020.07.019. Epub 2020 Sep 19.
The aim of this study was to examine the incidence, risk factors, and outcomes of patients with acute kidney injury (AKI) after surgery for acute type A aortic dissection (ATAAD) using the Nordic Consortium for Acute Type A Aortic Dissection registry.
Patients who underwent ATAAD surgery at 8 Nordic centers from 2005 to 2014 were analyzed for AKI according to the RIFLE criteria. Patients who died intraoperatively, those who had missing baseline or postoperative serum creatinine, and patients on preoperative renal replacement therapy were excluded.
AKI occurred in 382 of 941 patients (40.6%), and postoperative dialysis was required for 105 patients (11.0%). Renal malperfusion was present preoperatively in 42 patients (5.1%), of whom 69.0% developed postoperative AKI. In multivariable analysis patient-related predictors of AKI included age (per 10 years; odds ratio [OR], 1.30; 95% confidence interval [CI], 1.15-1.48), body mass index >30 kg/m (OR, 2.16; 95% CI, 1.51-3.09), renal malperfusion (OR, 4.39; 95% CI, 2.23-9.07), and other malperfusion (OR, 2.10; 95% CI, 1.55-2.86). Perioperative predictors were cardiopulmonary bypass time (per 10 minutes; OR, 1.04; 95% CI, 1.02-1.07) and red blood cell transfusion (OR per transfused unit, 1.08; 95% CI, 1.06-1.10). Rates of 30-day mortality were 17.0% in the AKI group compared with 6.6% in the non-AKI group (P < .001). In 30-day survivors AKI was an independent predictor of long-term mortality (hazard ratio, 1.86; 95% CI; 1.24-2.79).
AKI is a common complication after surgery for ATAAD and independently predicts adverse long-term outcome. Of note one-third of patients presenting with renal malperfusion did not develop postoperative AKI, possibly because of restoration of renal blood flow with surgical repair. Mortality risk persists beyond the perioperative period, indicating that close clinical follow-up of these patients is required.
本研究旨在使用北欧急性 A 型主动脉夹层联盟登记处，调查 8 家北欧中心 2005 年至 2014 年间接受急性 A 型主动脉夹层（ATAAD）手术患者的急性肾损伤（AKI）发生率、风险因素和结局。
根据 RIFLE 标准，对 8 家北欧中心的 941 名接受 ATAAD 手术的患者进行 AKI 分析。排除术中死亡、基线或术后血清肌酐缺失以及术前接受肾脏替代治疗的患者。
941 例患者中 382 例（40.6%）发生 AKI，105 例（11.0%）需要术后透析。42 例患者术前存在肾灌注不良（5.1%），其中 69.0%发生术后 AKI。多变量分析显示，与 AKI 相关的患者相关预测因素包括年龄（每增加 10 岁；比值比[OR]，1.30；95%置信区间[CI]，1.15-1.48）、体重指数（BMI）>30kg/m（OR，2.16；95%CI，1.51-3.09）、肾灌注不良（OR，4.39；95%CI，2.23-9.07）和其他灌注不良（OR，2.10；95%CI，1.55-2.86）。围手术期预测因素包括体外循环时间（每增加 10 分钟；OR，1.04；95%CI，1.02-1.07）和红细胞输注（每输注单位的 OR，1.08；95%CI，1.06-1.10）。AKI 组的 30 天死亡率为 17.0%，而非 AKI 组为 6.6%（P<0.001）。在 30 天幸存者中，AKI 是长期死亡率的独立预测因素（危险比，1.86；95%CI；1.24-2.79）。
AKI 是 ATAAD 手术后的常见并发症，并独立预测不良的长期结局。值得注意的是，三分之一出现肾灌注不良的患者并未发生术后 AKI，这可能是由于手术修复恢复了肾血流。围手术期后死亡率持续存在，表明需要对这些患者进行密切的临床随访。
