A retrospective study of analysis of risk factors of postoperative acute kidney injury in acute Stanford type A aortic dissection

doi:10.3877/cma.j.issn.2096-1537.2017.04.009

Abstract

Abstract:

Objective

To determine the risk factors of acute kidney injury (AKI) following type Stanford A Aortic Dissection (AD) operation.

Methods

We retrospectively analyzed the clinical data of 78 patients with Stanford A AD who underwent operation from Jun 2012 though Dec 2016. The patients were divided into AKI and non-AKI groups according to the KDIGO definition 2012. The risk factors of AKI were evaluated by comparing the clinical data of two groups.

Results

Of all included patients, 45(57.7%) patients developed to AKI and 36(46.2%) patients received renal replacement therapy (RRT). The hospital mortality was 7.7%. Univariate analysis revealed that preoperative creatinine (t=16.395, P<0.001), cardiopulmonary bypasstime (t=2.274, P=0.026), deep hypothermic circulatory arrest time (t=3.278, P=0.002), blood transfusion during operation (t=16.448, P<0.001), operation time (t=3.703, P<0.001), oxygenation index≤100 mmHg (t=11.341, P<0.001) postoperation were risk factors of AKI. Multivariate logistic analysis showed that preoperative creatinine(OR=11.364, 95%CI: 1.363~8.258, P=0.032) and oxygenation index≤100 mmHg (OR=15.263, 95%CI: 1.152~7.382, P=0.043) following-operation were independent risk factors for AKI.

Conclusion

Elevated preoperative creatinine level and oxygenation index≤100 mmHg following operation were independent risk factors of AKI in acute type A dissection surgery patients.

Key words: Dissection of aorta, Complication, Acute kidney injury, Risk factors

Haipeng Shi, Xiuzhe Wang, Xiaojing Yang, Yanmei Xia, Weidong Wu, wenjing Wu, Lingbo Yang. A retrospective study of analysis of risk factors of postoperative acute kidney injury in acute Stanford type A aortic dissection[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(04): 275-279.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2017.04.009

https://icu.cma-cmc.com.cn/EN/Y2017/V03/I04/275

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References 17

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组别	例数	年龄（岁，±s）	性别（例，男/女）	人体质量指数（kg/m²，±s）	术前合并高血压[例数（%）]	发病至入院时间（h，±s）
AKI组	45	52.4±8.8	40/5	27.6±2.8	36（80.0%）	32.3±12.8
非AKI组	33	49.7±11.2	32/1	26.3±3.6	24（72.8%）	29.6±16.2
统计值		t=1.192	χ²=1.751	t=1.794	χ²=0.567	t=0.822
P值		0.237	0.186	0.077	0.451	0.414

组别	例数	年龄（岁，±s）	性别（例，男/女）	人体质量指数（kg/m²，±s）	术前合并高血压[例数（%）]	发病至入院时间（h，±s）
AKI组	45	52.4±8.8	40/5	27.6±2.8	36（80.0%）	32.3±12.8
非AKI组	33	49.7±11.2	32/1	26.3±3.6	24（72.8%）	29.6±16.2
统计值		t=1.192	χ²=1.751	t=1.794	χ²=0.567	t=0.822
P值		0.237	0.186	0.077	0.451	0.414

组别	例数	术前肌酐值（μmol/L，±s）	体外循环时间（min，±s）	主动脉阻断时间（min，±s）	深低温停循环时间（min，±s）	术中输血量（ml，±s）
AKI组	45	120.5±9.9	209.9±36.6	89.6±26.4	36.5±12.2	1450.0±120.5
非AKI组	33	86.4±7.8	189.5±42.4	76.9±32.9	26.5±14.7	850.0±200.5
统计值		t=16.395	t=2.274	t=1.890	t=3.278	t=16.448
P值		<0.001	0.026	0.063	0.002	<0.001
组别	例数	全弓置换术[例数（%）]	手术时间（min，±s）	术后氧合指数（mmHg，±s）	术后机械通气时间（d，±s）	术后平均动脉压（mmHg，±s）	术后90 d死亡率[例数（%）]
AKI组	45	26（57.8%）	295.5±34.3	89.0±12.3	8.9±5.7	78.6±20.4	5（11.1%）
非AKI组	33	17（51.5%）	264.8±38.6	139.0±25.9	7.8±2.5	84.0±11.5	1（3.0%）
统计值		χ²=0.302	t=3.703	t=11.341	t=1.037	t=1.368	χ²=1.751
P值		0.583	<0.001	<0.001	0.303	0.175	0.186

组别	例数	术前肌酐值（μmol/L，±s）	体外循环时间（min，±s）	主动脉阻断时间（min，±s）	深低温停循环时间（min，±s）	术中输血量（ml，±s）
AKI组	45	120.5±9.9	209.9±36.6	89.6±26.4	36.5±12.2	1450.0±120.5
非AKI组	33	86.4±7.8	189.5±42.4	76.9±32.9	26.5±14.7	850.0±200.5
统计值		t=16.395	t=2.274	t=1.890	t=3.278	t=16.448
P值		<0.001	0.026	0.063	0.002	<0.001
组别	例数	全弓置换术[例数（%）]	手术时间（min，±s）	术后氧合指数（mmHg，±s）	术后机械通气时间（d，±s）	术后平均动脉压（mmHg，±s）	术后90 d死亡率[例数（%）]
AKI组	45	26（57.8%）	295.5±34.3	89.0±12.3	8.9±5.7	78.6±20.4	5（11.1%）
非AKI组	33	17（51.5%）	264.8±38.6	139.0±25.9	7.8±2.5	84.0±11.5	1（3.0%）
统计值		χ²=0.302	t=3.703	t=11.341	t=1.037	t=1.368	χ²=1.751
P值		0.583	<0.001	<0.001	0.303	0.175	0.186

影响因素	B	SE	Wald值	OR值	95%CI	P值
术前肌酐值	2.322	1.014	5.246	11.364	1.363~8.258	0.032
体外循环时间	0.831	0.468	3.152	2.361	0.918~5.787	0.076
深低温停循环时间	1.235	0.742	2.770	3.425	0.807~14.628	0.096
术中输血量	1.397	1.308	1.141	4.043	0.315~50.899	0.286
手术时间	0.159	0.629	0.064	1.172	0.342~4.021	0.802
术后氧合指数（≤100 mmHg）	2.358	1.188	3.948	15.263	1.152~7.382	0.043

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