Wang Dongxu, Yang Chen, Wang Han, Ye Mengmeng, Xue Chao, Wang Weiguang, Yu Bo, Ren Kai, Jin Zhenxiao, Yu Shiqiang, Duan Weixun
Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China.
Department of Integrated Medicine, Zhongyi-Northeast International Traditional Chinese Medicine Hospital, Shenyang, China.
Front Med (Lausanne). 2025 Jan 6;11:1495502. doi: 10.3389/fmed.2024.1495502. eCollection 2024.
Acute type A aortic dissection (ATAAD) is a life-threatening condition that often requires total aortic arch replacement (TAR) combined with frozen elephant trunk (FET) implantation. Despite advancements in surgical techniques and preoperative management, postoperative acute kidney injury (AKI) remains a prevalent complication that significantly affects patient prognosis, particularly severe AKI. The aim of this study was to investigate the predictive value of perioperative lactate levels in severe postoperative AKI after TAR.
A cohort analysis of 328 patients who underwent TAR with frozen elephant trunk implantation at Xijing Hospital, Xi'an, China, between September 2019 and September 2023 was conducted. Patients were categorized according to AKI severity into non-AKI, mild-AKI, and severe-AKI cohorts, and lactate levels were measured at nine perioperative time points. The primary endpoint was severe AKI (Kidney Disease: Improving Global Outcomes stage 3). Uni-and multivariate logistic regression analyses were performed to identify risk factors for severe AKI. Subgroup analysis substantiated the robustness of lactate levels in predicting severe AKI.
In total, 45.4% of patients developed mild AKI postoperatively and 20.7% developed severe AKI. Patients with severe postoperative AKI exhibited higher preoperative lactate levels. Multivariate stepwise backward logistic regression analysis identified lactate levels at 12 h postoperatively ([Lac], cutoff value: 3.3 mmol/L; sensitivity: 63.2%; specificity: 72.3%) as an independent predictor of severe AKI. The subgroup analysis underscored the consistent predictive capacity of Lac. The 30-day mortality rate was markedly elevated in the severe-AKI cohort, with deceased patients exhibiting a significantly higher Lac.
Among patients with acute type A aortic dissection undergoing TAR, high perioperative lactate levels were closely associated with postoperative AKI. Lac is a reliable and effective predictor of severe postoperative AKI, highlighting its clinical utility in risk stratification and management strategies.
急性A型主动脉夹层（ATAAD）是一种危及生命的疾病，通常需要进行全主动脉弓置换术（TAR）并植入冰冻象鼻支架（FET）。尽管手术技术和术前管理取得了进展，但术后急性肾损伤（AKI）仍然是一种常见的并发症，严重影响患者预后，尤其是严重AKI。本研究的目的是探讨围手术期乳酸水平对TAR术后严重AKI的预测价值。
对2019年9月至2023年9月在中国西安西京医院接受TAR并植入冰冻象鼻支架的328例患者进行队列分析。根据AKI严重程度将患者分为非AKI、轻度AKI和重度AKI队列，并在围手术期9个时间点测量乳酸水平。主要终点是严重AKI（改善全球肾脏病预后组织3期）。进行单因素和多因素逻辑回归分析以确定严重AKI的危险因素。亚组分析证实了乳酸水平在预测严重AKI方面的稳健性。
总共45.4%的患者术后发生轻度AKI，20.7%发生严重AKI。术后发生严重AKI的患者术前乳酸水平较高。多因素逐步向后逻辑回归分析确定术后12小时的乳酸水平（[Lac]，临界值：3.3 mmol/L；敏感性：63.2%；特异性：72.3%）是严重AKI的独立预测因素。亚组分析强调了Lac一致的预测能力。严重AKI队列的30天死亡率显著升高，死亡患者的Lac明显更高。
在接受TAR的急性A型主动脉夹层患者中，围手术期高乳酸水平与术后AKI密切相关。Lac是术后严重AKI的可靠有效预测指标，突出了其在风险分层和管理策略中的临床应用价值。
