Acute Kidney Injury After Acute Repair of Type A Aortic Dissection
Acute Kidney Injury After Acute Repair of Type A Aortic Dissection
复制标题
DOI：
10.1016/j.athoracsur.2020.07.019
复制
发表时间：
2021-03-19
影响因子：
4.6
通讯作者：
Gudbjartsson, Tomas
中科院分区：
文献类型：
--
作者：
Helgason, Dadi;Helgadottir, Solveig;Gudbjartsson, Tomas
背景本研究的目的是使用北欧急性A型主动脉夹层联合会登记表检查急性A型主动脉夹层（ATAAD）手术后急性肾损伤（阿基）患者的发病率、危险因素和结局。根据步枪标准，对2005年至2014年在8家北欧中心接受ATAAD手术的患者进行阿基分析。排除术中死亡、基线或术后血清肌酐缺失、术前接受肾脏替代治疗的患者。941例患者中有382例（40.6%）发生阿基，105例患者（11.0%）需要术后透析。42例患者（5.1%）术前存在肾灌注不良，其中69.0%发生术后阿基。在多变量分析中，阿基的患者相关预测因素包括年龄（每10年;比值比[OR]，1.30; 95%置信区间[CI]，1.15-1.48），体重指数>30 kg/m（2）（OR，2.16; 95%CI，1.51-3.09）、肾灌注不良（OR，4.39; 95%CI，2.23-9.07）和其他灌注不良（OR，2.10; 95%CI，1.55-2.86）。围手术期预测因素为心肺转流时间（每10分钟; OR，1.04; 95% CI，1.02-1.07）和红细胞输注（每输注单位OR，1.08; 95% CI，1.06-1.10）。阿基组的30天死亡率为17.0%，而非AKI组为6.6%（P <0.001）。在30天存活者中阿基是长期死亡率的独立预测因子（风险比，1.86; 95%CI; 1.24-2.79）。阿基是ATAAD术后常见的并发症，可独立预测不良长期结局。值得注意的是，三分之一存在肾灌注不良的患者未发生术后阿基，可能是因为手术修复恢复了肾血流。死亡风险持续超过围手术期，表明需要对这些患者进行密切的临床随访。(C)2021年美国胸外科医师协会
Background. The aim of this study was to examine the incidence, risk factors, and outcomes of patients with acute kidney injury (AKI) after surgery for acute type A aortic dissection (ATAAD) using the Nordic Consortium for Acute Type A Aortic Dissection registry.Methods. Patients who underwent ATAAD surgery at 8 Nordic centers from 2005 to 2014 were analyzed for AKI according to the RIFLE criteria. Patients who died intra-operatively, those who had missing baseline or post-operative serum creatinine, and patients on preoperative renal replacement therapy were excluded.Results. AKI occurred in 382 of 941 patients (40.6%), and postoperative dialysis was required for 105 patients (11.0%). Renal malperfusion was present preoperatively in 42 patients (5.1%), of whom 69.0% developed post-operative AKI. In multivariable analysis patient-related predictors of AKI included age (per 10 years; odds ra -tio [OR], 1.30; 95% confidence interval [CI], 1.15-1.48), body mass index >30 kg/m(2) (OR, 2.16; 95% CI, 1.51-3.09), renal malperfusion (OR, 4.39; 95% CI, 2.23-9.07), and other malperfusion (OR, 2.10; 95% CI, 1.55-2.86). Peri-operative predictors were cardiopulmonary bypass time (per 10 minutes; OR, 1.04; 95% CI, 1.02-1.07) and red blood cell transfusion (OR per transfused unit, 1.08; 95% CI, 1.06-1.10). Rates of 30-day mortality were 17.0% in the AKI group compared with 6.6% in the non-AKI group (P < .001). In 30-day survivors AKI was an inde-pendent predictor of long-term mortality (hazard ratio, 1.86; 95% CI; 1.24-2.79).Conclusions. AKI is a common complication after sur-gery for ATAAD and independently predicts adverse long-term outcome. Of note one-third of patients pre -senting with renal malperfusion did not develop post-operative AKI, possibly because of restoration of renal blood flow with surgical repair. Mortality risk persists beyond the perioperative period, indicating that close clinical follow-up of these patients is required. (C) 2021 by The Society of Thoracic Surgeons