Department of Vascular Surgery, Guy's and St Thomas' NHS Trust, London, UK.
Department of Cardiovascular Sciences, University of Leicester, UK; Leicester Vascular Institute, Glenfield Hospital, Leicester, UK.
Eur J Vasc Endovasc Surg. 2023 Feb;65(2):256-262. doi: 10.1016/j.ejvs.2022.10.032. Epub 2022 Oct 21.
Acute kidney injury (AKI) is common in patients with aortic diseases; however, it has not been extensively studied in acute type B aortic dissection (TBAD). AKI is known to be associated with adverse kidney outcomes and premature death. This study investigated the incidence and impact of AKI in patients with acute TBAD.
This was a retrospective study including data from two tertiary vascular centres in the UK. Case notes and electronic records were reviewed for consecutive patients presenting with acute symptomatic TBAD. Patients were managed according to a uniform clinical protocol; both patients who underwent surgery and those managed conservatively were included in this analysis. Serum creatinine values were used to calculate the number of patients who developed AKI, based on validated Kidney Disease Improving Global Outcomes definitions. Associations between incidence of AKI, death, and Major Adverse Kidney Events (MAKE; defined as death, dialysis and/or drop in estimated glomerular filtration rate > 25%) were explored.
Overall, 66 (42.6%) of 155 patients developed AKI within one week of presenting with TBAD. Of these, 23 patients (34.8%) had stage 1, 26 patients (39.4%) stage 2, and 17 patients (25.8%) stage 3 AKI. MAKE at 30 and 90 days occurred in 17 (11.0%) and 12 patients (7.7%), respectively. AKI was associated with significantly worse outcomes, with a 24.2% mortality rate in the AKI group compared with 7.8% among those with no AKI (p <.001); this association was also significant in adjusted analyses, both in patients who did and did not undergo surgery.
AKI is very common among patients presenting with acute TBAD, even in clinically uncomplicated disease. There was a significant association with mortality and MAKE, whether patients underwent surgery or not. This warrants further investigation to better understand the underlying causes of the AKI and investigate management strategies which may improve outcomes.
急性肾损伤（AKI）在主动脉疾病患者中很常见；然而，在急性 B 型主动脉夹层（TBAD）患者中尚未广泛研究。已知 AKI 与不良肾脏结局和过早死亡有关。本研究调查了急性 TBAD 患者 AKI 的发生率和影响。
这是一项回顾性研究，纳入了英国两个三级血管中心的数据。对连续出现急性症状性 TBAD 的患者的病历和电子记录进行了回顾。根据统一的临床方案对患者进行管理；手术和保守治疗的患者均纳入本分析。根据验证的肾脏病改善全球结局（KDIGO）定义，使用血清肌酐值计算发生 AKI 的患者人数。探讨 AKI 的发生率、死亡和主要不良肾脏事件（MAKE；定义为死亡、透析和/或估计肾小球滤过率下降>25%）之间的关联。
总体而言，155 例患者中有 66 例（42.6%）在出现 TBAD 后一周内发生 AKI。其中，23 例（34.8%）为 1 期 AKI，26 例（39.4%）为 2 期 AKI，17 例（25.8%）为 3 期 AKI。30 天和 90 天的 MAKE 发生率分别为 17 例（11.0%）和 12 例（7.7%）。AKI 与预后显著恶化相关，AKI 组的死亡率为 24.2%，而无 AKI 组的死亡率为 7.8%（p<.001）；在调整分析中，手术和非手术患者均存在显著关联。
即使在临床无并发症的疾病中，急性 TBAD 患者中 AKI 也很常见。与死亡率和 MAKE 显著相关，无论患者是否接受手术。这需要进一步研究，以更好地了解 AKI 的潜在原因，并研究可能改善预后的管理策略。
