Acute Kidney Injury Following Acute Repair of Type A Aortic Dissection
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Acute Kidney Injury Following Acute Repair of Type A Aortic Dissection. / Helgason, Dadi; Helgadottir, Solveig; Ahlsson, Anders; Gunn, Jarmo; Hjortdal, Vibeke; Hansson, Emma C; Jeppsson, Anders; Mennander, Ari; Nozohoor, Shahab; Zindovic, Igor; Olsson, Christian; Ragnarsson, Stefan Orri; Sigurdsson, Martin I; Geirsson, Arnar; Gudbjartsson, Tomas.
I: The Annals of Thoracic Surgery, Bind 111, Nr. 4, 2021, s. 1292-1298.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Acute Kidney Injury Following Acute Repair of Type A Aortic Dissection
AU - Helgason, Dadi
AU - Helgadottir, Solveig
AU - Ahlsson, Anders
AU - Gunn, Jarmo
AU - Hjortdal, Vibeke
AU - Hansson, Emma C
AU - Jeppsson, Anders
AU - Mennander, Ari
AU - Nozohoor, Shahab
AU - Zindovic, Igor
AU - Olsson, Christian
AU - Ragnarsson, Stefan Orri
AU - Sigurdsson, Martin I
AU - Geirsson, Arnar
AU - Gudbjartsson, Tomas
N1 - Copyright © 2020. Published by Elsevier Inc.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: The aim of this study was to examine the incidence, risk factors and outcomes of patients with acute kidney injury (AKI) following surgery for acute type A aortic dissection (ATAAD) using the NORCAAD registry.METHODS: Patients that underwent ATAAD surgery at eight Nordic centers from 2005-2014 were analyzed for AKI according to the RIFLE-criteria. Patients who died intraoperatively, those who had missing baseline or postoperative serum creatinine (SCr), and patients on preoperative RRT, were excluded.RESULTS: AKI occurred in 382/941 (40.6%) patients and postoperative dialysis was required for 105 (11.0%) patients. Renal malperfusion was present preoperatively in 42 (5.1%) patients, of whom 69.0% developed postoperative AKI.In multivariable analysis, patient-related predictors of AKI included age (per 10 years, OR=1.30, 95% CI:1.15-1.48), body mass index>30 kg/m2 (OR=2.16, 95% CI:1.51-3.09), renal malperfusion (OR=4.39, 95% CI:2.23-9.07) and other malperfusion (OR:2.10, 95% CI:1.55-2.86). Perioperative predictors were cardiopulmonary bypass time (per 10 minutes, OR=1.04, 95% CI:1.02-1.07) and red blood cell transfusion (OR=1.08, 95% CI:1.06-1.10). Rates of 30-day mortality were 17.0% in the AKI group compared with 6.6% in the non-AKI group (p<0.001). In 30-day survivors, AKI was an independent predictor of long-term mortality (HR=1.86, 95% CI:1.24-2.79).CONCLUSIONS: AKI is a common complication following surgery for ATAAD and independently predicts adverse long-term outcome. Of note, one-third of patients presenting with renal malperfusion did not develop postoperative AKI, possibly due to restoration of renal blood flow with surgical repair. Mortality risk persists beyond the perioperative period, indicating that close clinical follow-up of these patients is required.
AB - BACKGROUND: The aim of this study was to examine the incidence, risk factors and outcomes of patients with acute kidney injury (AKI) following surgery for acute type A aortic dissection (ATAAD) using the NORCAAD registry.METHODS: Patients that underwent ATAAD surgery at eight Nordic centers from 2005-2014 were analyzed for AKI according to the RIFLE-criteria. Patients who died intraoperatively, those who had missing baseline or postoperative serum creatinine (SCr), and patients on preoperative RRT, were excluded.RESULTS: AKI occurred in 382/941 (40.6%) patients and postoperative dialysis was required for 105 (11.0%) patients. Renal malperfusion was present preoperatively in 42 (5.1%) patients, of whom 69.0% developed postoperative AKI.In multivariable analysis, patient-related predictors of AKI included age (per 10 years, OR=1.30, 95% CI:1.15-1.48), body mass index>30 kg/m2 (OR=2.16, 95% CI:1.51-3.09), renal malperfusion (OR=4.39, 95% CI:2.23-9.07) and other malperfusion (OR:2.10, 95% CI:1.55-2.86). Perioperative predictors were cardiopulmonary bypass time (per 10 minutes, OR=1.04, 95% CI:1.02-1.07) and red blood cell transfusion (OR=1.08, 95% CI:1.06-1.10). Rates of 30-day mortality were 17.0% in the AKI group compared with 6.6% in the non-AKI group (p<0.001). In 30-day survivors, AKI was an independent predictor of long-term mortality (HR=1.86, 95% CI:1.24-2.79).CONCLUSIONS: AKI is a common complication following surgery for ATAAD and independently predicts adverse long-term outcome. Of note, one-third of patients presenting with renal malperfusion did not develop postoperative AKI, possibly due to restoration of renal blood flow with surgical repair. Mortality risk persists beyond the perioperative period, indicating that close clinical follow-up of these patients is required.
U2 - 10.1016/j.athoracsur.2020.07.019
DO - 10.1016/j.athoracsur.2020.07.019
M3 - Journal article
C2 - 32961133
VL - 111
SP - 1292
EP - 1298
JO - The Annals of Thoracic Surgery
JF - The Annals of Thoracic Surgery
SN - 0003-4975
IS - 4
ER -
ID: 250599135