Incidence- and In-hospital Mortality-Related Risk Factors of Acute Kidney Injury Requiring Continuous Renal Replacement Therapy in Patients Undergoing Surgery for Acute Type a Aortic Dissection

Chen, Xuelian; Zhou, Jiaojiao; Fang, Miao; Yang, Jia; Wang, Xin; Wang, Siwen; Li, Linji; Zhu, Tao; Ji, Ling; Yang, Lichuan

doi:10.3389/fcvm.2021.749592

Cited by 12 publications

(18 citation statements)

References 50 publications

(59 reference statements)

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“…Some conventional risk factors that have been known to be associated with worse outcomes after ATAAD surgery, including preoperative sCr, preoperative CRP, prolonged CPB times, and PMV also predicted the requirement for CRRT as suggested in our study and other previous studies ( 37 ). Compare to traditional indicators, the measurement of lactate has several advantages: rapidity, simplicity, convenient, and capability of repeated assessments.…”

Section: Discussionsupporting

confidence: 83%

Early dynamic behavior of lactate in predicting continuous renal replacement therapy after surgery for acute type A aortic dissection

Wang

Xu²,

Kang³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundIt has been well known that hyperlactatemia is an independent risk factor for postoperative mortality in patients who received acute type A aortic dissection (ATAAD) surgery. Some patients may require the assistance of continuous renal replacement therapy (CRRT) for acute postoperative renal deficiency and often associate with increased mortality rate. This study aimed to examine the association between the early dynamic change of lactate levels and postoperative CRRT in ATAAD patients who received surgical repairment.MethodsThis retrospective study included 503 patients who received ATAAD surgeries. Serum lactate levels were measured before operation and at 0, 1, 3, 6, 12, 24 h post intensive care unit (ICU) admission. We examined the association between dynamic changes of lactate and CRRT.ResultsAmong all patients, 19.9% (100 patients) required CRRT. Our data showed that the lactate levels were higher in the CRRT group at all timepoints compared to the non-CRRT group. In a multivariate model, lactate levels at 12 h post ICU admission [odds ratio (OR), 1.362; p = 0.007] was identified as an independent predictor for requiring CRRT. Unsurprisingly, 30-day mortality in the CRRT group (41%) was 8.2 times higher than in the non-CRRT group (5%). To better understand the associations between CRRT and lactate levels, patients in the CRRT group were further stratified into the non-survivor group (n = 41) and survivor group (n = 59) based on the 30-day mortality. Elevated lactate levels measured upon ICU admission (OR, 1.284; p = 0.001) and decreased 24 h lactate clearance (OR, 0.237; p = 0.039) were independent risk factors for 30-day mortality in patients who received CRRT. The area under the curve to predict requirement for CRRT at 6 and 12 h post CICU admission were 0.714 and 0.722, respectively, corresponding to lactate cut-off levels of 4.15 and 2.45 mmol/L.ConclusionThe CRRT is commonly required in patients who received ATAAD surgery and often associated with worse mortality. Early dynamic changes of lactate levels can be used to predict the requirement of postoperative CRRT.

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Section: Discussionsupporting

confidence: 83%

Early dynamic behavior of lactate in predicting continuous renal replacement therapy after surgery for acute type A aortic dissection

Wang

Xu²,

Kang³

et al. 2022

Front. Cardiovasc. Med.

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“…Evidence from the previous studies reported the incidence of postoperative CRRT use in patients undergoing surgery with aTAAD was 11-27%, and the mortality in such patients was significantly higher than in patients who were not. [63][64][65] Our study confirmed these phenomena. We performed concomitant CABG in two clinical scenarios, type B and type C coronary artery involvement clarified via intraoperative exploration 66 and difficult CPB weaning considered to be related to insufficient coronary artery blood flow.…”

supporting

confidence: 88%

Short- and Mid-Term Survival Prediction in Patients with Acute Type A Aortic Dissection Undergoing Surgical Repair: Based on the Systemic Immune-Inflammation Index

Li¹,

Zhang²,

Baraghtha³

et al. 2022

JIR

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Purpose The postoperative survival of patients with acute type A aortic dissection (aTAAD) remains unsatisfactory. The current study developed an easy-to-use survival prediction model and calculator. Methods A total of 496 patients with aTAAD undergoing surgical repair were included in this study. The systemic immune-inflammation index (SII) and other clinical features were collected and subjected to logistic and Cox regression analyses. The survival prediction model was based on Cox regression analyses and exhibited as a nomogram. For convenience of use, the nomogram was further developed into calculator software. Results We demonstrated that a higher preoperative SII was associated with in-hospital death (OR: 4.116, p < 0.001) and a higher postoperative overall survival rate (HR: 2.467, p < 0.001) in aTAAD patients undergoing surgical repair. A survival prediction model and calculator based on SII and four other clinical features were developed. The overall C-index of the model was 0.743. The areas under the curves (AUCs) of the 1- and 3-month and 1- and 3-year survival probabilities were 0.73, 0.71, 0.71 and 0.72, respectively. The model also showed good calibration and clinical utility. Conclusion Preoperative SII is significantly associated with postoperative survival. Based on SII and other clinical features, we created the first easy-to-use prediction model and calculator for predicting the postoperative survival rate in aTAAD patients, which showed good prediction performance.

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“…The role of obesity in aortic disease has been controversial. Several previous studies have shown that obesity was not significantly associated with mortality through aortic dissection but only increases perioperative complications and ventilation time ( 7 , 41 , 42 ). The BMI of patients also had no effect on the early major adverse outcomes and mid-term survival by continuous grouping ( 8 , 9 ).…”

Section: Discussionmentioning

confidence: 95%

Obesity Increases In-Hospital Mortality of Acute Type A Aortic Dissection Patients Undergoing Open Surgical Repair: A Retrospective Study in the Chinese Population

Pan

Xing

Yang

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveThe prevalence of obesity is increasing worldwide, and the role of the obesity paradox in cardiovascular surgery remains controversial. In this study, we redefined obesity according to the Chinese criteria and examined the relationship between obesity and in-hospital mortality in patients with acute type A aortic dissection (AAD) undergoing open surgical repair.Materials and MethodsA total of 289 patients with AAD (between 2014 and 2016) were divided into the non-obese group and obese group for correlation analysis, general information, demographic factors, blood biochemistry, surgical details, and complications, which were used as covariates. Survival was estimated by the Kaplan–Meier method, and any differences in survival were evaluated with a stratified log-rank test. Least Absolute Shrinkage and Selection Operator (LASSO) regression and logistic regression were used to evaluate the effect and interaction of obesity on surgical mortality.ResultsAll the 289 patients had a mean age of 48.64 (IQR 44.00–55.00) and 74.39% were men. Of the 289 patients, 228 were non-obese (78.89%) and 61 were obese (21.11%). Patients with obesity were younger and more prone to unstable blood pressure [systolic blood pressure (SBP) and diastolic blood pressure (DBP)], preoperative hypoxemia and delirium, prolonged operative time, and surgical wound deep infection (p < 0.05). In the fully adjusted model, we observed an increased risk of in-hospital mortality in patients with obesity after fine-tuning other covariates including age and sex (HR = 2.65; 95% CI = 1.03 to 6.80; p = 0.042). The interaction suggested that obesity was more likely to cause death in elderly patients (age ≥ 60), although it was more common in younger patients (test for interaction, p = 0.012).ConclusionObesity, interacting with age, increases the risk of in-hospital mortality in patients with AAD undergoing open surgical repair. Although more verification is needed, we believe these findings provide further evidence for the treatment of AAD.

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Incidence- and In-hospital Mortality-Related Risk Factors of Acute Kidney Injury Requiring Continuous Renal Replacement Therapy in Patients Undergoing Surgery for Acute Type a Aortic Dissection

Cited by 12 publications

References 50 publications

Early dynamic behavior of lactate in predicting continuous renal replacement therapy after surgery for acute type A aortic dissection

Early dynamic behavior of lactate in predicting continuous renal replacement therapy after surgery for acute type A aortic dissection

Short- and Mid-Term Survival Prediction in Patients with Acute Type A Aortic Dissection Undergoing Surgical Repair: Based on the Systemic Immune-Inflammation Index

Obesity Increases In-Hospital Mortality of Acute Type A Aortic Dissection Patients Undergoing Open Surgical Repair: A Retrospective Study in the Chinese Population

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