Background Acute kidney injury （AKI） is common after surgery for acute aortic dissection （AAD） and increases in-hospital and long-term mortality. However, few data exist on the clinical and prognostic relevance of...Background Acute kidney injury （AKI） is common after surgery for acute aortic dissection （AAD） and increases in-hospital and long-term mortality. However, few data exist on the clinical and prognostic relevance of early preoperative AKI in patients with type A AAD We aimed to determine the incidence and predictors of preoperative AKI and the impact of AKI on in-hospital outcomes in patients with type A AAD. Methods From May 2009 to June 2014, we retrospectively enrolled 178 patients admitted to our hospital within 48 h from symp- tom onset and receiving open surgery for type A AAD. The patients were divided into no AKI and AKI groups and staged with AKI severity according to the KDIGO criteria before surgery. Results AKI occurred in 41 patients （23.0%）. The incidence of in-hospital complications was significantly higher in patients with preoperative AKI compared to no AKI （41.5% vs. 9.5%, P 〈 0.001）, including renal infarction （7.3% vs. 0, P = 0.012）, and it increased with AKI severity （Ptrend〈 0.001）. Patients with AKI had higher in-hospital mortality compared with pa- tients without AKI, although no significant difference was found （14.6% vs. 5.1%, P = 0.079）. Multivariate analysis indicated that male gender, diastolic blood pressure on admission and bilateral renal artery involvement were independent predictors of preoperative AKI in patients with type A AAD. Conclusions Early AKI before surgery was common in patients with type A AAD, and was associated with increased in-hospital complications. Male gender, diastolic blood pressure on admission and bilateral renal artery involvement were major predictors for preoperative AKI.展开更多
基金This study was supported in part by grants from the Beijing Natural Science Foundation （7141003）, Beijing Municipal Science ＆ Technology Commission （Z14110700 2514014）, and Beijing Municipal Administration of Hospitals Incubating Program （PX2016048）.
文摘Background Acute kidney injury （AKI） is common after surgery for acute aortic dissection （AAD） and increases in-hospital and long-term mortality. However, few data exist on the clinical and prognostic relevance of early preoperative AKI in patients with type A AAD We aimed to determine the incidence and predictors of preoperative AKI and the impact of AKI on in-hospital outcomes in patients with type A AAD. Methods From May 2009 to June 2014, we retrospectively enrolled 178 patients admitted to our hospital within 48 h from symp- tom onset and receiving open surgery for type A AAD. The patients were divided into no AKI and AKI groups and staged with AKI severity according to the KDIGO criteria before surgery. Results AKI occurred in 41 patients （23.0%）. The incidence of in-hospital complications was significantly higher in patients with preoperative AKI compared to no AKI （41.5% vs. 9.5%, P 〈 0.001）, including renal infarction （7.3% vs. 0, P = 0.012）, and it increased with AKI severity （Ptrend〈 0.001）. Patients with AKI had higher in-hospital mortality compared with pa- tients without AKI, although no significant difference was found （14.6% vs. 5.1%, P = 0.079）. Multivariate analysis indicated that male gender, diastolic blood pressure on admission and bilateral renal artery involvement were independent predictors of preoperative AKI in patients with type A AAD. Conclusions Early AKI before surgery was common in patients with type A AAD, and was associated with increased in-hospital complications. Male gender, diastolic blood pressure on admission and bilateral renal artery involvement were major predictors for preoperative AKI.
