Risk Factors for Stage 3 Acute Kidney Injury after Acute Stanford Type A Aortic Dissection Repair.

Abstract

Background: This study explored the risk factors for developing severe acute kidney injury (AKI, stage 3) after acute type A aortic dissection (ATAAD) surgery.

Methods: In total, 163 patients with ATAAD who underwent Bentall or ascending aortic replacement combined with total arch replacement and elephant trunk repair at our center between January 2017 and December 2022 were retrospectively analyzed. Postoperative stage 3 AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes criteria. Multivariate logistic regression analyses were performed to identify independent risk factors for postoperative stage 3 AKI.

Results: Stage 3 AKI occurred in 35 patients (21.5%), who demonstrated a significantly higher in-hospital mortality than the stage 0 to 2 AKI group (risk ratio = 4.88, χ² = 11.557; p = 0.001). Preoperative serum creatinine (sCr), preoperative estimated glomerular filtration rate, chronic kidney disease history, long-term smoking history, surgical method, cardiopulmonary bypass time, aortic cross-clamp time, postoperative low cardiac output, and postoperative stroke were significantly associated with stage 3 AKI (p < 0.05). Multivariate logistic regression analysis identified preoperative sCr (odds ratio [OR] = 1.023, 95% confidence interval [CI]: 1.013-1.034; p = 0.000), surgical method (OR = 0.089, 95% CI: 0.025-0.319; p = 0.000), and postoperative low cardiac output (OR = 15.214, 95% CI: 1.765-131.135; p = 0.013) as independent risk factors for AKI3. Preoperative sCr could effectively predict postoperative AKI3 (area under the curve = 0.747; cutoff value: 123.5 μmol/L; sensitivity: 63%; specificity: 83%).

Conclusion: Postoperative AKI3 was significantly associated with in-hospital mortality after ATAAD surgery. Preoperative sCr, surgical method, and postoperative low cardiac output are independent risk factors for postoperative AKI3. Patients with preoperative sCr >123.5 µmol/L should be closely monitored for increased risk.