Intraoperative hemodynamics in prediction of postoperative kidney injury after type a aortic dissection surgery: a retrospective cohort study.

IF 4.3
Annals of medicine Pub Date : 2025-12-01 Epub Date: 2025-03-05 DOI:10.1080/07853890.2025.2474859
Lihai Chen, Yi Cheng, Xinyi Bu, Chen Zhang, Jie Sun, Xuesheng Liu, Siyu Kong, Yali Ge, Hongwei Shi, Jifang Zhou
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Abstract

Background: Type A aortic dissection (TAAD) is a severe cardiovascular condition associated with high risks for postoperative complications, particularly renal dysfunction. This study investigated whether intraoperative hypotension and venous congestion are important predictors of postoperative kidney injury and major adverse events.

Methods: We retrospectively analyzed 543 adults undergoing TAAD surgery (2016-2023). Primary outcomes were acute kidney injury (AKI) and acute kidney disease (AKD). Secondary outcomes included death, stroke and composite outcome. Patients were divided into four groups: AKI only, AKD only, AKI and AKD, Non-AKI or AKD. We used restricted cubic spline and multivariate logistic regression models to adjust for confounding factors.

Results: AKI or AKD was significantly associated with each 10-minute epoch of central venous pressure (CVP) ≥10, 12, 16, 20 mmHg (all p < 0.001), with each 60-minute epoch of CVP ≥10, 12, 16, 20 mmHg area under the curve (AUC) (all p < 0.001). Regarding death, a 6% to 13% increase rate for each 10-minute epoch of CVP ≥10, 12, 16, 20 mmHg (all p ≤ 0.003), a 5% to 21% increase for each 60-minute epoch of CVP ≥10, 12, 16, 20 mmHg AUC (all p < 0.001). In terms of stroke risk, a 5% increase rate for every 10-minute increase in the CVP AUC above 16 mmHg, and an 11% increased risk for CVP AUC above 20 mmHg (p = 0.039 and p = 0.031, respectively).

Conclusion: Elevated CVP and lower MAP levels were linked to postoperative AKI and AKD risk. CVP showed stronger associations with mortality and stroke. Optimizing perioperative hemodynamic management may improve individualized interventions.

术中血流动力学对 A 型主动脉夹层手术后肾损伤的预测:一项回顾性队列研究。
背景:A型主动脉夹层(TAAD)是一种严重的心血管疾病,与术后并发症,特别是肾功能障碍的高风险相关。本研究探讨术中低血压和静脉充血是否是术后肾损伤和主要不良事件的重要预测因素。方法:我们回顾性分析了543例接受TAAD手术的成年人(2016-2023)。主要结局为急性肾损伤(AKI)和急性肾病(AKD)。次要结局包括死亡、中风和综合结局。患者分为四组:单纯AKI、单纯AKD、AKI合并AKD、非AKI或AKD。我们使用限制三次样条和多元逻辑回归模型来调整混杂因素。结果:AKI或AKD与中心静脉压(CVP)≥10、12、16、20 mmHg每10分钟显著相关(所有p≤0.003),CVP≥10、12、16、20 mmHg AUC每60分钟增加5% ~ 21%(所有p分别= 0.039和p = 0.031)。结论:CVP升高和MAP降低与术后AKI和AKD风险相关。CVP与死亡率和中风有更强的关联。优化围手术期血流动力学管理可以改善个体化干预。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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