Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
J Cardiothorac Surg. 2020 Oct 15;15(1):315. doi: 10.1186/s13019-020-01365-y.
To identify risk factors and long-term outcomes of acute kidney injury (AKI) in young patients who underwent type A acute aortic dissection (TA-AAD) emergency surgeries.
This retrospective study enrolled 121 consecutive patients less than 40 years old who received TA-AAD emergency surgeries between January 2014 to December 2018 in Nanjing Drum Tower hospital. The diagnosis of AKI was made based on the KDIGO criteria. Multivariable regression analysis was performed to identify risk factors for postoperative AKI. Kaplan-Meier curves were generated to compare long-term outcomes between patients with and without AKI complication after TA-AAD surgeries.
Among all enrolled patients, AKI occurred in 51 patients (42.1%) and renal replacement therapy (RRT) was required in 15 patients (12.4%). The development of postoperative AKI was associated with increased 30-day mortality (P = 0.041), longer ICU stay time (P < 0.001) and hospital stay time (P = 0.006). Multivariable analysis indicated that elevated preoperative serum cystatin C (sCyC) (OR = 6.506, 95% CI: 1.852-22.855, P = 0.003) was the only independent risk factor for developing AKI. The areas under the receiver-operating characteristic curve (AUC) of preoperative sCyC was 0.800 (95% CI: 0.719, 0.882). Preoperative sCyC had a sensitivity of 64.7% and a specificity of 83.8% in diagnosing postoperative AKI with a cut-off value of 0.895 mg/L. In addition, our data suggested there was no difference discovered regarding long-term cumulative survival rate between patients with and without AKI during a median 29 months follow-up period.
Postoperative AKI after TA-AAD surgeries was relatively common in young patients and associated with increased short-term mortality. Elevated preoperative sCyC was identified as an independent risk factor for AKI with potential diagnostic merit.
确定行 A 型急性主动脉夹层（TA-AAD）急诊手术的年轻患者发生急性肾损伤（AKI）的风险因素和长期结局。
本回顾性研究纳入了 2014 年 1 月至 2018 年 12 月在南京鼓楼医院接受 TA-AAD 急诊手术的 121 例年龄小于 40 岁的连续患者。AKI 的诊断基于 KDIGO 标准。多变量回归分析用于确定术后 AKI 的风险因素。Kaplan-Meier 曲线用于比较 TA-AAD 手术后有无 AKI 并发症患者的长期结局。
在所有纳入的患者中，51 例（42.1%）发生 AKI，15 例（12.4%）需要肾脏替代治疗（RRT）。术后 AKI 的发生与 30 天死亡率增加（P=0.041）、ICU 住院时间延长（P<0.001）和住院时间延长（P=0.006）相关。多变量分析表明，术前血清胱抑素 C（sCyC）升高（OR=6.506，95%CI：1.852-22.855，P=0.003）是发生 AKI 的唯一独立危险因素。术前 sCyC 的受试者工作特征曲线下面积（AUC）为 0.800（95%CI：0.719，0.882）。术前 sCyC 以 0.895mg/L 为截断值，诊断术后 AKI 的灵敏度为 64.7%，特异性为 83.8%。此外，在中位 29 个月的随访期间，我们的数据表明，AKI 患者和无 AKI 患者的长期累积生存率无差异。
年轻患者行 TA-AAD 手术后 AKI 较为常见，与短期死亡率增加相关。术前 sCyC 升高被确定为 AKI 的独立危险因素，具有潜在的诊断价值。
