[Incidence and risk factors of acute kidney injury after aortic dissection surgery].

Abstract

Objective: To investigate the incidence and risk factors of acute kidney injury (AKI) after aortic dissection surgery. Methods: The data of patients who underwent aortic dissection surgery in the Department of Cardiovascular Surgery of Jiangsu Provincial People's Hospital from January 2020 to June 2024 were retrospectively collected. The primary endpoint was the incidence of AKI within 7 days postoperatively, and the secondary endpoint was the occurrence of AKI combined with dialysis (AKI-D). Logistic regression was used to analyze the influencing factors of AKI and AKI-D. The Shapley additive explanation (SHAP) method was employed to interpret the results of the multivariate logistic regression analysis and quantify the contribution of each factor. Results: A total of 850 patients aged [M (Q₁, Q₃)] 56 (48, 66) years were included, with 679 males (79.9%) and 171 females (20.1%). The study identified 490 cases (57.6%) with Stanford type A aortic dissection and 360 cases (42.4%) with type B. The incidence of AKI within 7 days postoperatively was 40.1% (341/850), with the incidence of AKI in type A dissection significantly higher than that in type B dissection [60.8% (298/490) vs 11.9% (43/360), P<0.001]. AKI-D occurred in 19.5% (166/850) of patients, and the in-hospital mortality rate was 8.8% (75/850). The independent risk factors for postoperative AKI, ranked by contribution, were emergency surgery (OR=2.38, 95%CI: 1.39-4.06; SHAP=0.085), surgery duration (per 1-hour increase, OR=1.18, 95%CI: 1.09-1.29; SHAP=0.084), Stanford type A (OR=2.04, 95%CI: 1.09-3.81; SHAP=0.062), baseline serum creatinine (per 10 μmol/L increase, OR=1.12, 95%CI: 1.06-1.18; SHAP=0.058), intraoperative erythrocyte transfusion (for each additional U, OR=1.09, 95%CI: 1.02-1.15; SHAP=0.037), D-dimer (per 1 mg/L increase, OR=1.03, 95%CI: 1.01-1.06; SHAP=0.036). The independent risk factors for AKI-D, ranked by contribution, were surgical duration (per 1-hour increase, OR=1.31, 95%CI: 1.19-1.45; SHAP=0.083), baseline serum creatinine (per 10 μmol/L increase, OR=1.16, 95%CI: 1.09-1.24; SHAP=0.053), emergency surgery (OR=2.60, 95%CI: 1.34-5.01; SHAP=0.045), female gender (OR=2.73,95%CI: 1.57-4.76; SHAP=0.040), D-dimer (per 1 mg/L increase, OR=1.05, 95%CI: 1.02-1.07; SHAP=0.033), poor renal perfusion classification (missing, OR=2.34, 95%CI: 1.34-4.09; SHAP=0.032), intraoperative erythrocyte transfusion (per 1 U increase, OR=1.07, 95%CI: 1.01-1.14; SHAP=0.021). Conclusions: The incidence of AKI after aortic dissection surgery is high, particularly in patients with type A dissection. Prolonged operation time and elevated preoperative serum creatinine are common risk factors for both AKI and AKI-D.