Long-Term Survival in Patients With Acute Kidney Injury After Acute Type A Aortic Dissection Repair
Long-Term Survival in Patients With Acute Kidney Injury After Acute Type A Aortic Dissection Repair
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DOI：
10.1016/j.athoracsur.2016.05.006
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发表时间：
2016-12-01
影响因子：
4.6
通讯作者：
Sanui, Masamitsu
中科院分区：
文献类型：
--
作者：
Sasabuchi, Yusuke;Kimura, Naoyuki;Sanui, Masamitsu
背景虽然急性肾损伤（阿基）被认为是急性A型主动脉夹层（AAAD）术后的严重并发症，但阿基的长期影响仍不清楚。本研究的目的是调查AAAD术后阿基患者的长期生存率。本研究纳入了1990年至2011年在日本自治医科大学琦玉医学中心接受AAAD手术的403例患者。根据肾脏疾病改善全球结局标准确定术后阿基。Kaplan-Meier生存分析和考克斯比例风险回归分析阿基分期与术后长期生存率之间的关系。在403例患者中，181例（44.9%）发生了术后阿基。Kaplan-Meier法估计的长期生存率在无阿基患者与1、2和3阿基患者之间存在显著差异（p < 0.001）。与无阿基患者相比，1、2和3阿基患者的长期生存风险比分别为1.38（95%置信区间[CI]：0.84 - 2.26）、1.82（95% CI：0.95 - 3.51）和3.79（95% CI：1.95 - 7.37）。阿基患者出院后死于心血管疾病的人数多于非阿基患者（1.8% vs 6.0%，p = 0.03）。3期阿基与AAAD术后较低的长期生存率显著相关。出院后的患者随访（重点关注心血管问题）可能使AAAD手术后阿基存活的患者受益。(C)2016胸外科医师协会
Background. Although acute kidney injury (AKI) is known as a serious complication after operation for acute type A aortic dissection (AAAD), the long-term impact of AKI remains unclear. The aim of the present study is to investigate the long-term survival in patients with AKI after operation for AAAD.Methods. This study included 403 patients who underwent operation for AAAD from 1990 to 2011 at Jichi Medical University, Saitama Medical Center. Postoperative AKI was identified according to the Kidney Disease Improving Global Outcomes criteria. Kaplan-Meier survival analysis and Cox proportional hazards regression were modeled to analyze the association between the AKI stage and postoperative long-term survival.Results. Of 403 patients, 181 (44.9%) experienced postoperative AKI. Kaplan-Meier estimates for long-term survival were significantly different among patients without AKI and patients with stage 1, 2, and 3 AKI (p < 0.001). Hazard ratios of long-term survival for patients with stages 1, 2, and 3 AKI compared with patients without AKI were 1.38 (95% confidence interval [CI]: 0.84 to 2.26), 1.82 (95% CI: 0.95 to 3.51), and 3.79 (95% CI: 1.95 to 7.37), respectively. More patients with AKI died because of cardiovascular disease after discharge than patients without AKI (1.8% versus 6.0%, p = 0.03).Conclusions. Stage 3 AKI is significantly associated with lower long-term survival after operation for AAAD. Patient follow-up after discharge that focuses on cardiovascular issues may benefit patients who survive AKI after AAAD operation. (C) 2016 by The Society of Thoracic Surgeons