Risk factors and long-term outcomes of elderly patients complicating with acute kidney injury after type A acute aortic dissection surgery: a retrospective study

Abstract Background Perioperative coagulopathy and blood transfusion are common in patients undergoing Stanford type A acute aortic dissection (AAD) repair. The autologous platelet-rich plasmapheresis (aPRP) technique is a blood conservation approach to reduce blood transfusions and morbidity in patients at high risk of bleeding. The purpose of this study was to analyze the effect of aPRP on outcomes, especially in postoperative acute kidney injury (post-AKI), in patients undergoing AAD surgery. Methods Six hundred sixty patients were divided into aPRP and non-aPRP groups according to aPRP use. The primary endpoint was the difference in the incidence of post-AKI between two groups. The secondary endpoints were risk factors for post-AKI and to assess clinical outcomes. The risk factors associated with post-AKI were calculated, and all outcomes were adjusted by propensity-score matching analysis. Results A total of 272 patients (41.2%) received aPRP, whereas 388 were in the non-aPRP group. Compared to non-aPRP group, the occurrence of post-AKI increased by 14.1% (p = 0.002) and 11.1% (p = 0.010) with and without propensity adjustment in the aPRP group, respectively. The aPRP group required fewer intraoperative transfusions (p < 0.05) and shortened the duration of mechanical ventilation (p < 0.05) than those in the non-aPRP group. Multiple regression analyses showed that aPRP (odds ratio: 1.729, 95% confidence interval: 1.225–2.440; p < 0.001) was one of the independent risk factors for post-AKI. Conclusions The use of aPRP significantly reduced intraoperative blood transfusions and decreased postoperative mortality-adjusted mechanical ventilation. However, aPRP use was independently associated with an increased hazard of post-AKI after adjusting for confounding factors.

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Impact of autologous platelet rich plasma use on postoperative acute kidney injury in type A acute aortic dissection repair: A retrospective cohort analysis

10.21203/rs.3.rs-66758/v1 ◽

2020 ◽

Author(s):

Jiaqi Tong ◽

Liang Cao ◽

Liwei Liu ◽

Mu Jin

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Cohort Analysis ◽

Kidney Injury ◽

Type A ◽

Blood Transfusions ◽

Autologous Platelet

Abstract Backround: Perioperative coagulopathy and blood transfusion are common in patients undergoing Stanford type A acute aortic dissection (AAD) repair. The autologous platelet-rich plasmapheresis (aPRP) technique is a blood conservation approach to reduce blood transfusions and morbidity in patients at high risk of bleeding. The purpose of this study was to analyze the effect of aPRP on outcomes, especially in postoperative acute kidney injury (post-AKI), in patients undergoing AAD surgery.Methods: Six hundred sixty patients were divided into aPRP and non-aPRP groups according to aPRP use. The primary endpoint was the difference in the incidence of post-AKI between two groups. The secondary endpoints were risk factors for post-AKI and to assess clinical outcomes. The risk factors associated with post-AKI were calculated, and all outcomes were adjusted by propensity-score matching analysis.Results: A total of 272 patients (41.2%) received aPRP, whereas 388 were in the non-aPRP group. Compared to non-aPRP group, the occurrence of post-AKI increased by 14.1% (p=0.002) and 11.1% (p=0.010) with and without propensity adjustment in the aPRP group, respectively. The aPRP group required fewer intraoperative transfusions (p<0.05) and shortened the duration of mechanical ventilation (p<0.05) than those in the non-aPRP group. Multiple regression analyses showed that aPRP (odds ratio: 1.729, 95% confidence interval: 1.225–2.440; p<0.001) was one of the independent risk factors for post-AKI.Conclusions: The use of aPRP significantly reduced intraoperative blood transfusions and decreased postoperative mortality-adjusted mechanical ventilation. However, aPRP use was independently associated with an increased hazard of post-AKI after adjusting for confounding factors.

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Risk factors and long-term outcomes of acute kidney injury complication after type A acute aortic dissection surgery in young patients

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01365-y ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Qiuyan Zong ◽

Min Ge ◽

Tao Chen ◽

Cheng Chen ◽

Zhigang Wang ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Independent Risk Factor ◽

Acute Aortic Dissection ◽

Young Patients ◽

Kidney Injury ◽

Long Term Outcomes ◽

Stay Time ◽

Postoperative Aki

Abstract Objective To identify risk factors and long-term outcomes of acute kidney injury (AKI) in young patients who underwent type A acute aortic dissection (TA-AAD) emergency surgeries. Methods This retrospective study enrolled 121 consecutive patients less than 40 years old who received TA-AAD emergency surgeries between January 2014 to December 2018 in Nanjing Drum Tower hospital. The diagnosis of AKI was made based on the KDIGO criteria. Multivariable regression analysis was performed to identify risk factors for postoperative AKI. Kaplan–Meier curves were generated to compare long-term outcomes between patients with and without AKI complication after TA-AAD surgeries. Results Among all enrolled patients, AKI occurred in 51 patients (42.1%) and renal replacement therapy (RRT) was required in 15 patients (12.4%). The development of postoperative AKI was associated with increased 30-day mortality (P = 0.041), longer ICU stay time (P < 0.001) and hospital stay time (P = 0.006). Multivariable analysis indicated that elevated preoperative serum cystatin C (sCyC) (OR = 6.506, 95% CI: 1.852–22.855, P = 0.003) was the only independent risk factor for developing AKI. The areas under the receiver-operating characteristic curve (AUC) of preoperative sCyC was 0.800 (95% CI: 0.719, 0.882). Preoperative sCyC had a sensitivity of 64.7% and a specificity of 83.8% in diagnosing postoperative AKI with a cut-off value of 0.895 mg/L. In addition, our data suggested there was no difference discovered regarding long-term cumulative survival rate between patients with and without AKI during a median 29 months follow-up period. Conclusions Postoperative AKI after TA-AAD surgeries was relatively common in young patients and associated with increased short-term mortality. Elevated preoperative sCyC was identified as an independent risk factor for AKI with potential diagnostic merit.

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Risk factors for acute kidney injury after surgery of type A acute aortic dissection: a meta-analysis

10.37766/inplasy2020.6.0100 ◽

2020 ◽

Author(s):

Lei Wang ◽

Yi Dong ◽

Xiaochai Lv ◽

Jianzhi Du ◽

Yongqiang Qiu ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Meta Analysis ◽

Kidney Injury ◽

Type A

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Impact of autologous platelet rich plasma use on postoperative acute kidney injury in type A acute aortic dissection repair: A retrospective cohort analysis

10.21203/rs.3.rs-66758/v2 ◽

2020 ◽

Author(s):

Jiaqi Tong ◽

Liang Cao ◽

Liwei Liu ◽

Mu Jin

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Cohort Analysis ◽

Kidney Injury ◽

Type A ◽

Blood Transfusions ◽

Autologous Platelet

Abstract Background Perioperative coagulopathy and blood transfusion are common in patients undergoing Stanford type A acute aortic dissection (AAD) repair. The autologous platelet-rich plasmapheresis (aPRP) technique is a blood conservation approach to reduce blood transfusions and morbidity in patients at high risk of bleeding. The purpose of this study was to analyze the effect of aPRP on outcomes, especially in postoperative acute kidney injury (post-AKI), in patients undergoing AAD surgery.Methods Six hundred sixty patients were divided into aPRP and non-aPRP groups according to aPRP use. The primary endpoint was the difference in the incidence of post-AKI between two groups. The secondary endpoints were risk factors for post-AKI and to assess clinical outcomes. The risk factors associated with post-AKI were calculated, and all outcomes were adjusted by propensity-score matching analysis.Results A total of 272 patients (41.2%) received aPRP, whereas 388 were in the non-aPRP group. Compared to non-aPRP group, the occurrence of post-AKI increased by 14.1% (p=0.002) and 11.1% (p=0.010) with and without propensity adjustment in the aPRP group, respectively. The aPRP group required fewer intraoperative transfusions (p<0.05) and shortened the duration of mechanical ventilation (p<0.05) than those in the non-aPRP group. Multiple regression analyses showed that aPRP (odds ratio: 1.729, 95% confidence interval: 1.225–2.440; p<0.001) was one of the independent risk factors for post-AKI. Conclusions The use of aPRP significantly reduced intraoperative blood transfusions and decreased postoperative mortality-adjusted mechanical ventilation. However, aPRP use was independently associated with an increased hazard of post-AKI after adjusting for confounding factors.

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Risk Factors for Mortality in Acute Aortic Dissection Type A: A Centre Experience Over 15 Years

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1710002 ◽

2020 ◽

Author(s):

Mohamed Salem ◽

Christine Friedrich ◽

Alexander Thiem ◽

Katharina Huenges ◽

Thomas Puehler ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Mortality Rate ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Circulatory Arrest ◽

Kidney Injury ◽

Type A ◽

Aortic Dissection Type A

Abstract Introduction Acute aortic dissection Type A (AADA) is still associated with a high mortality rate and frequent postoperative complications. This study was designed to evaluate the risk factors for mortality in AADA patients. Patients and Methods This retrospective analysis included 344 consecutive patients who underwent surgery for AADA in moderate hypothermic circulatory arrest (20–24°C nasopharyngeal) between 2001 and 2016. Results The 30-day mortality rate was 18%. Nonsurvivors were significantly older (65.7 ± 12.0 years vs. 62.0 ± 12.5 years; p = 0.034) with significantly higher Euro-score II [15.4% (6.6; 23.0) vs. 4.63% (2.78; 9.88); p < 0.001)]. Intraoperatively, survivors had statistically shorter cardiopulmonary bypass times [163 (134; 206) vs. 198 min (150; 245); p = 0.001]. However, the hypothermic circulatory arrest time was similar between both groups. Postoperatively, the incidence of acute kidney injury (AKI) (55.9 vs. 15.2%; p < 0.001), stroke (27.9 vs. 12.1%; p = 0.002) and sepsis (18.0 vs. 2.1%; p < 0.001) were significantly higher among nonsurvivors. The multi-variable logistic regression confirmed that older age, previous cardiac surgery, preoperative cardiopulmonary resuscitation (CPR), blood transfusion and postoperative acute kidney injury (AKI) were independent risk factors for mortality. Conclusion Our analysis suggested that the reason for mortality was multifactorial, especially age, previous cardiac surgery, CPR, transfusion, as well as postoperative AKI were considered risk factors for mortality.

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Independent risk factors and the long-term outcomes for postoperative continuous renal replacement treatment in patients who underwent emergency surgery for type a acute aortic dissection

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01153-8 ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 2

Author(s):

Zhigang Wang ◽

Min Ge ◽

Tao Chen ◽

Cheng Chen ◽

Qiuyan Zong ◽

...

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Emergency Surgery ◽

Acute Aortic Dissection ◽

Type A ◽

Long Term Outcomes ◽

Replacement Treatment ◽

Independent Risk Factors

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Risk factors for acute kidney injury after initial acute aortic dissection and their effect on long-term mortality

Renal Replacement Therapy ◽

10.1186/s41100-016-0061-z ◽

2016 ◽

Vol 2 (1) ◽

Cited By ~ 4

Author(s):

Akiko Kato ◽

Eri Ito ◽

Naoki Kamegai ◽

Minami Mizutani ◽

Hiroya Shimogushi ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Kidney Injury ◽

Long Term Mortality

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Acute kidney injury in patients operated on for type A acute aortic dissection: incidence, risk factors and short-term outcomes

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa164 ◽

2020 ◽

Vol 31 (5) ◽

pp. 697-703 ◽

Cited By ~ 1

Author(s):

Zhigang Wang ◽

Min Ge ◽

Tao Chen ◽

Cheng Chen ◽

Qiuyan Zong ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Aortic Dissection ◽

Cystatin C ◽

Acute Aortic Dissection ◽

Kidney Injury ◽

Type A ◽

Short Term ◽

Postoperative Ventilation

Abstract OBJECTIVES Acute kidney injury (AKI) is a relatively common complication after an operation for type A acute aortic dissection and is indicative of a poor prognosis. We examined the risk factors for and the outcomes of developing AKI in patients being operated on for thoracic aortic diseases. METHODS We retrospectively analysed 712 patients with acute type A dissection who had deep hypothermic circulatory operations from January 2014 to December 2018, emphasizing those who developed AKI. Logistic regression models were used to identify predisposing factors for the postoperative development of AKI. RESULTS Among all enrolled patients, 359 (50.4%) had AKI; of these, 133 were diagnosed as stage 1 (18.7%), 126 were stage 2 (17.7%) and 100 were stage 3 (14.0%). Postoperative haemodialysis was required in 111 patients (15.9%). The development of AKI after aortic surgery contributed to the higher mortality rate within 30 days after surgery (P < 0.001), longer stay in the intensive care unit (P = 0.01) and longer hospital stay (P < 0.001). Binary logistic regression analysis showed that preoperative cystatin C levels [odds ratio (OR) 2.615, 95% confidence interval (CI) 1.139–6.002; P = 0.023] and postoperative ventilation time (OR 1.019, 95% CI 1.005–1.034; P = 0.009) were independent risk factors for developing AKI. Multiple ordinal logistic regression analyses showed that the preoperative cystatin C level (OR 2.921, 95% CI 1.542–5.540; P = 0.001) was an independent risk factor associated with the severity of AKI. CONCLUSIONS Our data suggested that the development of AKI after surgery for type A acute aortic dissection was common and associated with an increased short-term mortality rate. The preoperative cystatin C level was identified as an indicator for the occurrence and severity of AKI postoperatively. Furthermore, we discovered that longer postoperative ventilation time was also associated with the development of AKI.

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