A型主动脉夹层术后急性肾损伤危险因素与预测价值分析

Analysis of Risk factors and predictive value of acute kidney injuryafter type A aortic dissection surgery

目的探讨A型主动脉夹层术后急性肾损伤(AKI)的危险因素及其对术后发生AKI的预测价值。方法选取2015年1月至2021年12月在该院确诊并行A型主动脉夹层手术的111例患者作为研究对象,按照术后是否发生AKI分为AKI组(69例)和无AKI组(42例),比较两组临床资料,通过多因素Logistic回归分析术后发生AKI的危险因素,并绘制受试者工作特征(ROC)曲线评估相关危险因素对术后发生AKI的预测价值。结果AKI组与无AKI组术前白细胞计数、降钙素原(PCT)、血清肌酐,术中急诊手术占比、体外循环总时间、主动脉阻断时间、深低温停循环时间,以及术后重症监护病房滞留时间比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,术前白细胞计数升高(OR=1.204,95%CI:1.023~1.416,P=0.025)、术前PCT水平升高(OR=1.080,95%CI:1.014~1.447,P=0.004)、术中深低温停循环时间增加(OR=1.134,95%CI:1.044~1.232,P=0.003)是A型主动脉夹层术后发生AKI的独立危险因素。ROC曲线分析结果显示,术前白细胞计数、术前PCT水平、术中深低温停循环时间对A型主动脉夹层术后发生AKI的曲线下面积(AUC)分别为0.667、0.661、0.504,3项指标联合检测预测术后发生AKI的特异度、灵敏度及AUC分别为71.40%、72.50%、0.758。结论术前白细胞计数升高、术前PCT水平升高及术中深低温停循环时间增加是A型主动脉夹层术后发生AKI的独立危险因素,具有一定的预测价值,3项指标联合检测对术后发生AKI的预测效能更高。

Objective To investigate the risk factors and predictive value of acute kidney injury(AKI)after type A aortic dissection surgery.Methods Results Methods A total of 111 patients who were diagnosed with type A aortic dissection and underwent surgery in the First Affiliated Hospital of Chongqing Medical University from January 2015 to December 2021 were selected as the research objects.According to whether AKI occurred after surgery,they were divided into AKI group(69 cases)and non-AKI group(42 cases),the clinical data of the 2 groups were compared.The risk factors of postoperative AKI were analyzed multivariate Logistic regression,and the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of related risk factors for postoperative AKI.Results There were significant differences in preoperative white cell count(WBC),procalcitonin(PCT),serum creatinine,the proportion of emergency operation,the total time of cardiopulmonary bypass,aortic cross-clamp time,deep hypothermia circulatory arrest time and postoperative intensive care unit(ICU)retention time between AKI group and control group(P<0.05).Multivariate Logistic regression analysis showed that preoperative WBC increased(OR=1.204,95%CI:1.023-1.416,P=0.025),preoperative PCT level increased(OR=1.080,95%CI:1.014-1.447,P=0.004),and the deep hypothermia circulatory arrest time during operation increased(OR=1.134,95%CI:1.044-1.232,P=0.003)were independent risk factors for postoperative AKI with type A aortic dissection.The results of ROC curve analysis showed that the area under the curve(AUC)of preoperative WBC,preoperative PCT levels and intraoperative deep hypothermia time for AKI after type A aortic dissection surgery were 0.667,0.661,0.504 respectively.The specificity,sensitivity and AUC of combined detection of the 3 indicators for predicting postoperative AKI were 71.40%,72.50%and 0.758 respectively.Conclusion Elevated preoperative WBC,PCT and prolonged intraoperative deep hypothermia circulatory arrest time are independent risk factors for postoperative AKI in patients with type A aortic dissection,and have certain predictive value.Combined detection of the 3 indicators has higher predictive efficiency for postoperative AKI.