Prediction of Acute Kidney Injury for Acute TypeA Aortic Dissection Patients Who UnderwentSun’s Procedure by a Perioperative Nomogram

Cardiorenal medicine

article

Zhang, Yuhui¹  Lan, Yongrong³  Chen, Tongyun²  Chen, Qingliang²  Guo, Zhigang²  Jiang, Nan² 

[1] Clinical School of Thoracic, Tianjin Medical University;Department of Cardiac Surgery, Tianjin Chest Hospital;Graduate School, Tianjin Medical University

关键词: Acute type A aortic dissection;    Sun’s procedure;    Acute kidney injury;    Risk prediction;    Nomogram;   

DOI  :  10.1159/000524907

学科分类：心脏病和心血管学

来源: S Karger AG

【 摘 要 】

Introduction: Postoperative acute kidney injury (AKI) occurs in 20–40% of acute type A aortic dissection (ATAAD) patients undergoing cardiac surgery. A predictive model could be developed to assess the probability of AKI in patients with ATAAD before and after cardiac surgery in a timely manner. Methods: This retrospective study enrolled a total of 224 patients with ATAAD. Patients were subjected to total arch replacement using a tetrafurcate graft with stented elephant trunk implantation according to Sun’s procedure. Statistical comparison for the collected data was done with Student’s t test or Mann-Whitney U test (continuous variables) and χ2 test (categorical variables). The independent predictors were screened by multivariate logistic regression analysis and then incorporated into a nomogram. The reliability of cardiac surgery-associated AKI (CSA-AKI) models was evaluated using the area under the receiver operating characteristic curve (AUC). Results: This study enrolled 224 ATAAD patients, including 53 patients with AKI and 171 patients without AKI. The incidence of ATAAD-induced AKI in the cohort was 23.66%. The screened predictors for AKI include iliac artery involvement, creatinine, D-dimer, autotransfusion, platelet-rich plasma reinfusion, nasal temperature, red blood cells, fresh frozen plasma, drainage, and mechanical ventilation. The calculated AUC values for model 1, model 2, model 3, and model 4 were 0.710, 0.777, 0.827, and 0.848, respectively. Model 4 was optimum for AKI risk scoring compared with model 1, model 2, and model 3. Conclusions: AKI prediction models were established for ATAAD patients using preoperative, intraoperative, and postoperative information. Particularly, model 4 shows superiority in risk prediction for CSA-AKI.

【 授权许可】

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