Guo Rutao, Chen Suwei, Ge Yipeng, Zhong Yongliang, Li Chengnan, Qiao Zhiyu, Hu Haiou, Zhu Junming
Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
J Thorac Dis. 2025 Apr 30;17(4):2126-2139. doi: 10.21037/jtd-24-1804. Epub 2025 Apr 22.
Acute type A aortic dissection (ATAAD) is a prevalent and life-threatening emergency in cardiovascular surgery. Acute kidney injury (AKI) is a common perioperative complication of ATAAD. The mechanism of occurrence is multi-factor. The traditional assessment of renal function might be postponed and better biomarkers are needed to predict AKI. This study simultaneously evaluated perioperative plasma neutrophil gelatinase-associated lipocalin (NGAL) levels during ATAAD surgery to predict the risk of postoperative.
Total of 104 ATAAD patients were included in this research. Blood samples were collected from the patients at different time points: before surgery (T1), at the end of hypothermic circulatory arrest (HCA) (T2), at the end of cardiopulmonary bypass (CPB) (T3), 24 hours post-operation (T4), and 48 hours post-operation (T5). The patients were grouped based on whether the AKI occurred after surgery, and we compared levels of plasma NGAL across different time points. Additionally, we constructed a multivariate logistic regression model using preoperative and intraoperative data from the patients, incorporating plasma NGAL as a predictor to assess its predictive capability.
Based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria, the occurrence of AKI among the 104 ATAAD patients was found to be 39.4% (41 out of 104). Within this group, 12 patients were categorized as KDIGO stage 1, 11 as stage 2, and 18 as stage 3; additionally, 14 patients required continuous renal replacement therapy (CRRT). Plasma NGAL levels were elevated at all measured time points for AKI patients compared to non-AKI group. Subgroup analysis revealed that plasma NGAL levels in patients with severe AKI (sAKI) consistently exceeded those in mild AKI (mAKI) cases, while no significant difference was observed between mAKI and non-AKI groups. Plasma NGAL demonstrated predictive capability for sAKI at each time point, with an area under the curve (AUC) of 0.739 [95% confidence interval (CI): 0.616-0.861; P<0.001] recorded at T5. Independent risk factors for postoperative AKI in ATAAD patients included preoperative ejection fraction [odds ratio (OR): 0.90; 95% CI: 0.81-0.99; P=0.043], D-dimer level (OR: 1.05; 95% CI: 1.01-1.09; P=0.01), and plasma NGAL level (OR: 1.02; 95% CI: 1.01-1.04; P=0.01).
The perioperative levels of plasma NGAL in patients who developed AKI after ATAAD were notably elevated compared to those without AKI. Furthermore, plasma NGAL demonstrated strong predictive capability for severe postoperative AKI.
急性A型主动脉夹层（ATAAD）是心血管外科中一种常见且危及生命的急症。急性肾损伤（AKI）是ATAAD常见的围手术期并发症。其发生机制是多因素的。传统的肾功能评估可能会延迟，需要更好的生物标志物来预测AKI。本研究同时评估了ATAAD手术期间围手术期血浆中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平，以预测术后风险。
本研究共纳入104例ATAAD患者。在不同时间点采集患者血样：手术前（T1）、低温循环停止（HCA）结束时（T2）、体外循环（CPB）结束时（T3）、术后24小时（T4）和术后48小时（T5）。根据患者术后是否发生AKI进行分组，并比较不同时间点血浆NGAL水平。此外，利用患者术前和术中数据构建多因素逻辑回归模型，将血浆NGAL作为预测因子，评估其预测能力。
根据改善全球肾脏病预后组织（KDIGO）标准，104例ATAAD患者中AKI的发生率为39.4%（104例中的41例）。在该组中，12例患者被分类为KDIGO 1期，11例为2期，18例为3期；此外，14例患者需要持续肾脏替代治疗（CRRT）。与非AKI组相比，AKI患者在所有测量时间点的血浆NGAL水平均升高。亚组分析显示，重度AKI（sAKI）患者的血浆NGAL水平始终高于轻度AKI（mAKI）患者，而mAKI组与非AKI组之间未观察到显著差异。血浆NGAL在每个时间点对sAKI均具有预测能力，T5时曲线下面积（AUC）为0.739 [95%置信区间（CI）：0.616 - 0.861；P<0.001]。ATAAD患者术后AKI的独立危险因素包括术前射血分数[比值比（OR）：0.90；95% CI：0.81 - 0.99；P = 0.043]、D - 二聚体水平（OR：1.05；95% CI：1.01 - 1.09；P = 0.01）和血浆NGAL水平（OR：1.02；95% CI：1.01 - 1.04；P = 0.01）。
与未发生AKI的患者相比，ATAAD后发生AKI的患者围手术期血浆NGAL水平显著升高。此外，血浆NGAL对术后重度AKI具有较强的预测能力。
