The Risk Factors And Risk Prediction Model For Acute Kidney Injury After Stanford Type A Aortic Dissection Surgery

Objective Acute Stanford type A aortic dissection is one of the most dangerous vascular diseases,with high morbidity and mortality.In recent years,with the advancement of medical technology,the prognosis of patients with Stanford type A aortic dissection has improved to some extent,but postoperative complications significantly affect the outcome of patients.It has been found that the incidence of acute kidney injury(AKI)after the surgery for Stanford type A aortic dissection is very high,and the prognosis of these patients is poor.This study analyzes the independent risk factors for this complication after surgery,explores the possible pathogenesis,and provides evidence for early identification and prevention of high-risk patients with AKI after surgery,so as to reduce the incidence of AKI and improve the prognosis of patients.Methods This study selected adult patients with Stanford type A aortic dissection who underwent surgery in the department of cardiovascular surgery,Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2017 to September 2020.A total of 273 patients were enrolled in the study.The patients were divided into a postoperative AKI group of 68 cases and a non-AKI group of 205 cases according to the preoperative and postoperative creatinine values in reference to KIDGO standard of diagnosis.The medical history data and related clinical data of all patients were collected and retrospectively analyzed.All data analysis was performed using SPSS Statistics 25.0.The differences between the two groups of patients were analyzed through the single-factor analysis and the statistically significant factors were put into the multivariate logistic model for regression analysis to obtain independent risk factors for incidence of AKI after surgery for Stanford type A aortic dissection.A predictive model was established and the ROC curve was used to evaluate the model.Result According to the inclusion and exclusion criteria,a total of 273 patients with Stanford type A aortic dissection were finally enrolled,including 171 male patients and 102 female patients;among them 68 patients suffered postoperative AKI.The univariate analysis showed that in the AKI group,age,body mass index,hypertension,preoperative creatinine level,glomerular filtration rate,total number of white blood cells,percentage of neutrophils,absolute value of neutrophils,LVEF,whether renal artery was involved before operation,operation time,intraoperative extracorporeal circulation time,aortic block time,selective cerebral perfusion duration,the amount of blood transfused during the operation,the level of postoperative hypersensitivity C-reactive protein,the level of postoperative procalcitonin,the absolute value of postoperative white blood cells,the absolute value of postoperative neutrophils was statistically different from that of the group without AKI(α=0.05,P<0.05).The results of multivariate logistic regression analysis showed that: age(OR=1.088,95%CI: 0.981-1.206,P=0.048);preoperative creatinine level(OR=1.039,95%CI:1.003-1.077,P=0.035);involvement of the renal artery in aortic dissection(OR=8.619,95%CI: 3.742-19.855,P<0.01);operation time(OR=1.487,95%CI: 1.015-2.179,P=0.042)and the level of postoperative procalcitonin(OR=1.037,95%CI:1.000-1.075,P=0.018)were independent risk factors for the incidence of AKI in patients after surgery for Stanford type A aortic dissection.Based on the above results,a prediction model was established,and a total of 5 related factors were incorporated into the model.The area under the ROC curve of the prediction model was 0.896.The sensitivity of the model was 85.3%,and the specificity was 81.5%.Conclusion Our research suggests that the age,preoperative creatinine level,involvement of the renal artery in aortic dissection,operation duration,and postoperative procalcitonin in patients with Stanford type A aortic dissection are related to the incidence of AKI after surgery.The logistic model established in this study is able to successfully predict the risk of AKI after the surgery for Stanford type A aortic dissection,and the prediction performance is satisfactory.