Risk Factors And Clinical Study Of Early Acute Kidney Injury After Acute Stanford Type A Aortic Dissection

Objective: To analyze the risk factors for early acute injury after acute Stanford type A aortic dissection and its clinical study.Methods: A retrospective study was conducted on214 patients with acute Stanford type A aortic dissection who underwent surgical treatment in our hospital from January 2018 to December 2021.Patients with acute kidney injury within 7 days after surgery were assigned to the acute kidney injury group,and the rest were assigned to the non-acute kidney injury group.The general condition,preoperative,intraoperative and postoperative important clinical data of the two groups were compared.The risk factors of AKI within 7 days after surgery were analyzed by univariate and multivariate conditional Logistic regression analysis,and the ROC curve was drawn to analyze the predictive value.Results: In this study,The average age of 214 patients with ATAAD was 49.5±8.9 years,172 males and 42 females,the BMI was 26.4±4.0 Kg/㎡,143patients(66.8%)had a history of hypertension,79 patients(36.9%)had a history of smoking,and the average time from onset to surgery was 4.6±3.8 days,and 69 had AKI within 7 days after surgery,with an incidence of 32.2%.The AKI group had a higher postoperative stay in the intensive care unit,ventilator-assisted breathing time,and allcause mortality during hospitalization than the non-AKI group,and the all-cause mortality rate during postoperative hospitalization in the AKI group was 23.2%,which was 32.5times that of the non-AKI group.The statistically significant indicators of univariate analysis were included in multivariate logistic regression analysis : BMI [P=0.005,OR=1.243,95%CI(1.066～1.449)],extracorporeal circulation time [P=0.034,OR=1.014,95%CI(1.001～1.028)],postoperative urea [P=0.007,OR=1.343,95%CI(1.084～1.664)],postoperative creatinine [P=0.010,OR=1.038,95%CI(1.009～1.068)],postoperative lactic acid [P=0.012,OR=1.253,95%CI(1.051～1.493)] were statistically different(P<0.05).The area under the ROC curve of BMI,CPB time,postoperative urea nitrogen,postoperative creatinine and postoperative lactic acid were 0.639,0.647,0.826,0.870,0.659,respectively.Postoperative urea nitrogen and postoperative creatinine could predict the occurrence of AKI.Conclusion: BMI,cardiopulmonary circulation time,postoperative urea,postoperative creatinine and lactate 2 hours after surgery are independent risk factors for early AKI in patients with ATAAD.Shortening CPB time can reduce the occurrence of AKI.In-hospital all-cause mortality,intensive care unit stay time and mechanical ventilation time were significantly increased in AKI patients after surgery.