Impact of preoperative elevated serum creatinine on long-term outcome of patients undergoing aortic repair with Stanford A dissection: a retrospective matched pair analysis
Impact of preoperative elevated serum creatinine on long-term outcome of patients undergoing aortic repair with Stanford A dissection: a retrospective matched pair analysis
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DOI：
10.1177/1753944718798345
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发表时间：
2018-11-01
影响因子：
2.3
通讯作者：
Wahlers, Thorsten
中科院分区：
文献类型：
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作者：
Eghbalzadeh, Kaveh;Sabashnikov, Anton;Wahlers, Thorsten
背景资料：本研究的目的是确定术前血清肌酐升高是否会影响斯坦福大学A型急性主动脉夹层（AAD）患者接受主动脉修复术的长期结局。方法：2006年1月至2015年4月，共有240例诊断为斯坦福大学A型AAD的患者接受了手术修复。应用倾向评分匹配，得到73对，包括一组正常和一组术前肌酐水平升高。队列的基线和术前临床特征平衡良好。比较了两组的早期术后变量以及长达9年随访的估计生存率。此外，急性术后肾损伤及其严重程度对长期survival.Results的影响进行了分析：患有斯坦福大学AAD与肌酐水平升高的患者比例为31.3%（n = 75）。倾向匹配后，人口统计学、合并症、术前基线和临床特征方面无统计学显著差异。术后匹配的肌酐升高患者在重症监护室的时间更长（p < 0.001）和总住院时间（p = 0.002），插管时间延长（p = 0.014），更需要血液滤过（p < 0.001），暂时性神经系统疾病（p = 0.16）、感染（p = 0.005）的发生率较高，脓毒症的发生率有较高的趋势（p = 0.097）。然而，30天死亡率（20.5% vs 20.5%，p = 1.000）和长期总生存率无显著差异。此外，根据急性肾损伤网络，急性肾损伤的发病率或不同阶段均未显示出两组在长期存活方面的任何统计学显著差异[对数秩p = 0.636，Breslow（广义Wilcoxon）p = 0.470，Tarone-Ware p = 0.558]。因斯坦福大学A AAD接受手术修复的肌酐水平升高的患者显示出更高的早期术后并发症发生率。然而，该患者队列的30天死亡率和长期生存率并未显著受损。
Background: The aim of the present study was to determine whether raised preoperative serum creatinine affected the long-term outcome in patients undergoing surgical aortic repair for Stanford A acute aortic dissection (AAD).Methods: A total of 240 patients diagnosed with Stanford A AAD underwent surgical repair from January 2006 to April 2015. A propensity score matching was applied, resulting in 73 pairs consisting of one group with normal and one group with preoperative elevated creatinine levels. The cohorts were well balanced for baseline and preoperative clinical characteristics. Both groups were compared regarding their early postoperative variables, as well as estimated survival with up to 9-year follow up. Also, the impact of acute postoperative kidney injury and its severity on long-term survival was analyzed.Results: The proportion of patients suffering Stanford A AAD with raised creatinine levels was 31.3% (n = 75). After propensity matching, there were no statistically significant differences regarding demographics, comorbidities, preoperative baseline and clinical characteristics. Postoperatively matched patients with elevated creatinine had longer intensive care unit (p < 0.001) and total hospital stay (p = 0.002), prolonged intubation times (p = 0.014), higher need for hemofiltration (p < 0.001), higher incidence of temporary neurological disorders (p = 0.16), infection (p = 0.005), and trend toward higher incidence of sepsis (p = 0.097). However, there were no significant differences regarding 30-day mortality (20.5% versus 20.5%, p = 1.000) and long-term overall survival. Further, neither the incidence nor the different stages of acute kidney injury according to the Acute Kidney Injury Network showed any statistically significant differences in terms of long-term survival for both groups [log rank p = 0.636, Breslow (generalized Wilcoxon) p = 0.470, Tarone-Ware p = 0.558].Conclusions: Patients with elevated creatinine levels undergoing surgical repair for Stanford A AAD demonstrate higher rate of early postoperative complications. However, 30-day mortality and long-term survival in this patient cohort is not significantly impaired.