Abstract 17962: Acute Kidney Injury Increases Morbidity and Mortality After Surgery for Acute Type A Aortic Dissection
Background: Acute kidney injury (AKI) following cardiac surgery has been reported to increase morbidity and mortality. Acute type A aortic dissection (AAAD) remains a serious cardiovascular disease and can be associated with postoperative AKI, however little is known about its etiology and impact on clinical outcomes.
Methods and Results: We reviewed 403 patients who underwent AAAD repair between 1990 and 2011, excluding patients with chronic kidney disease (serum ceatinine (sCr) > 3.0 mg/dl or hemodialysis, n=12), supported by extracorporeal membrane oxygenation (n=14), or died within 48 hours of surgery (n=8). AKI was defined by the Acute Kidney injury Network (AKIN) criteria, using preoperative and postoperative sCr within 7 days after surgery. AKI occurred in 50% of patients (202/403), including 141 stage 1 (35%), 42 stage 2 (10%), and 19 stage 3 (5%). Hospital mortality was: no AKI- 2% (3/201), stage 1- 4% (6/141), stage 2- 12% (5/42), and stage 3- 26% (5/19). Logistic regression showed stage 2 (P=0.005) and stage 3 (P<0.001) with increased hospital mortality compared to the reference. Median ICU stay increased according to AKI classification: no AKI- 5 days (2-36 days), stage 1- 6 days (2-42 days), stage 2- 6 days (3-21 days), and stage 3- 13 days (4-78 days) (P<0.001). Logistic regression analysis showed all AKI groups with an increased risk of prolonged ventilation (>48 hour). Estimated 5-year survival: no AKI 86±3%, stage 1- 81±4%, stage 2- 61±9%, and stage 3- 57±11% (stage 2 and stage 3 decreased late survival compared to the reference, P<0.01). Logistic regression analysis identified estimated glomerular filtration rate (eGFR) < 60 l/min/1.73m2 (OR, 2.2; 95% CI, 1.5-3.5; P<0.001), male (OR, 2.0; 95% CI, 1.3-3.1; P=0.001), renal malperfusion (OR, 4.0; 95% CI, 1.3-12.7; P=0.016), and 200ml red blood cell transfusion (OR, 1.058; 95% CI, 1.01-1.11; P=0.02) as risk factors for AKI.
Conclusion: AKI increased morbidity and mortality after surgery for AAAD. AKI was associated with male gender, decreased eGFR, and renal malperfuion. Knowing the predictors of AKI should help optimize the postoperative management of patients treated for AAAD.
- © 2012 by American Heart Association, Inc.