The Incidence, Risk Factors and In-Hospital Mortality of Acute Kidney Injury in Patients After Surgery for Acute Type A Aortic Dissection: A Single-Center Retrospective Analysis of 335 Patients

Abstract

Background: Acute kidney injury (AKI) is a common complication of cardiac surgery, which could lead to increased morbidity and mortality. Acute type A aortic dissection (AAAD) is a life-threatening cardiac disease and can be closely related to post-operative AKI. However, data on the incidence of AKI defined by the newest Kidney Disease: Improving Global Outcomes (KDIGO) criteria and in-hospital mortality of a homogeneous population who underwent AAAD are limited. We aimed to investigate the incidence of AKI defined by the KDIGO criteria and the risk factors associated with the outcomes among AAAD-induced AKI patients. Methods: We reviewed 335 patients who underwent surgical treatment for AAAD between March 2009 and June 2016. We screened the patients' AKI status and analyzed probably risk factors of AKI and in-hospital mortality. Independent-sample t-test or Chi-square test was performed to identify differences between AKI and non-AKI groups and survivors with AKI and non-survivors with AKI, respectively. The logistic regression model was applied to identify independent risk factors. Results: AKI occurred in 71.94% of AAAD patients, including 85 stage 1 (35.26%), 77 stage 2 (31.95%), and 79 stage 3 (32.78%) patients. The in-hospital mortality rate was 21.16%. Logistic regression analysis showed that the body mass index, chronic kidney disease, chronic liver disease, cardiopulmonary bypass duration, red blood cell transfusion, and hypoproteinemia were the independent significant risk factors of the occurrence of post-operative AKI. The risk factors associated with in-hospital mortality among AAAD-induced AKI patients included AKI stage (odds ratio (OR), 3.322), deep hypothermic circulatory arrest (OR, 2.586), lactic acidosis (OR, 3.407), and continuous renal replacement therapy (OR, 3.156). Li et al. AKI After AAAD Surgery Conclusion: For AAAD patients undergoing surgery, AKI was a common complication, and it increased patients' mortality risk. Therefore, identifying the risk factors of AKI and preventing post-operative AKI are important for improving the post-operative outcomes of AAAD patients.

Risk factors and in-hospital mortality of postoperative hyperlactatemia in patients after acute type A aortic dissection surgery

“…The CPB duration in the majority of patients was 3–4 h, and the possibility of POHL increased a lot due to the very long CPB time. However, it was similar to the results of AADS-related studies at home and abroad [ 24 , 25 ]. This may be attributed to the complexity and difficulty of the AADS, which implies a possibility of higher postoperative lactate levels and increased incidence of POHL than other cardiac operations and thus higher mortality.…”

En Bloc Arch Reconstruction With the Frozen Elephant Trunk Technique for Acute Type a Aortic Dissection

“…AKI is a common complication after aortic surgery which is more likely associated with high mortality. In present study, we observed that 23 patients presented AKI and five patients required continuous renal replacement therapy because of renal failure after operation, which is in accordance with the results reported by Li et al ( 35 ). Open total aortic arch replacement is a complicated operation that includes the application of hypothermic circulatory arrest which can potentially lead to severe renal ischemic-reperfusion injury.…”

“…This means that the risk of renal tubular injury can be minimized by avoiding deep hypothermia and decreasing the CPB duration. Other risk factors of developing AKI underwent aortic arch surgery, which did have been found were older age, obesity, preoperative hypertension, chronic renal disease, emergency surgery, a higher number of red blood cell transfusion, and renal malperfusion due to the dissection itself or cardiac tamponade (35,36,39). As a result, emergency aortic surgery was strongly related to the development of postoperative AKI and might be known as a risk factor for AKI.…”

Impact of hyperbilirubinemia associated acute kidney injury on chronic kidney disease after aortic arch surgery: a retrospective study with follow-up of 1 year

“…Received more blood transfusion and blood loss increase the bilirubin level, and they are risk factors of HB following cardiac surgery [5]. Moreover, CPB time, cross-clamp time, received more blood transfusion and blood loss were also associated with AKI after cardiac surgery with CPB [19,20]. The similar risk factors of HB and AKI may explain the positive impact of HB on AKI and the poor outcomes of HB-AKI group in our study.…”