Jian-Cheng Zhu1, Shao-Liang Chen2, Guo-Zhen Jin3, Ming-Xue Shao3, Jing Kan3, Cun-Yu Lu4, Hui Xu5. 1. Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. Electronic address: zjcdexx@126.com. 2. Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. Electronic address: chmengx@126.com. 3. Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. 4. Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. 5. Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Abstract
BACKGROUND/ PURPOSE: Acute kidney injury (AKI) significantly increases the risk of mortality in patients following cardiovascular intervention procedures. This study was carried out to investigate the incidence, predictors, and prognostic implications of AKI after thoracic endovascular aortic repair (TEVAR) of Stanford type B aortic dissection. METHODS: A total of 156 patients with Stanford type B aortic dissection who underwent TEVAR were retrospectively analyzed between February 1, 2004 and October 31, 2011. Multivariable regression was used to predict risk factors for AKI. Association between baseline characteristics, postoperative AKI, and mortality during follow up was evaluated. RESULTS: AKI was identified in 48 (30.8%) of 156 patients, with seven (14.5%) patients requiring continuous renal replacement therapy. The in-hospital mortality rate was 0% in patients without AKI and 12.5% in those with AKI (p = 0.001). Univariate analysis identified preoperative chronic kidney disease, acute dissection, complicated dissection, malperfusion complications with comprehensive complications, and postoperative minimum estimated glomerular filtration rate within 48 hours as associated with AKI. Malperfusion complications [odds ratio (OR) = 4.828; 95% confidence interval (CI) = 1.163-20.03] were the only independent predictor of AKI. Patients suffering from AKI had a 14-fold increased risk for 30-day mortality (OR = 14.3; 95% CI = 1.7-118.4; p = 0.014) and a 10-fold increased risk for 1-year mortality (OR = 9.5; 95% CI = 2.02-44.9; p = 0.004). CONCLUSION: A significant rate of AKI was observed following TEVAR and was associated with an increase in 30-day and 1-year mortality. Malperfusion complications were identified as an independent predictor of AKI.
BACKGROUND/ PURPOSE:Acute kidney injury (AKI) significantly increases the risk of mortality in patients following cardiovascular intervention procedures. This study was carried out to investigate the incidence, predictors, and prognostic implications of AKI after thoracic endovascular aortic repair (TEVAR) of Stanford type B aortic dissection. METHODS: A total of 156 patients with Stanford type B aortic dissection who underwent TEVAR were retrospectively analyzed between February 1, 2004 and October 31, 2011. Multivariable regression was used to predict risk factors for AKI. Association between baseline characteristics, postoperative AKI, and mortality during follow up was evaluated. RESULTS: AKI was identified in 48 (30.8%) of 156 patients, with seven (14.5%) patients requiring continuous renal replacement therapy. The in-hospital mortality rate was 0% in patients without AKI and 12.5% in those with AKI (p = 0.001). Univariate analysis identified preoperative chronic kidney disease, acute dissection, complicated dissection, malperfusion complications with comprehensive complications, and postoperative minimum estimated glomerular filtration rate within 48 hours as associated with AKI. Malperfusion complications [odds ratio (OR) = 4.828; 95% confidence interval (CI) = 1.163-20.03] were the only independent predictor of AKI. Patients suffering from AKI had a 14-fold increased risk for 30-day mortality (OR = 14.3; 95% CI = 1.7-118.4; p = 0.014) and a 10-fold increased risk for 1-year mortality (OR = 9.5; 95% CI = 2.02-44.9; p = 0.004). CONCLUSION: A significant rate of AKI was observed following TEVAR and was associated with an increase in 30-day and 1-year mortality. Malperfusion complications were identified as an independent predictor of AKI.
Authors: Joana Gameiro; José Agapito Fonseca; Marta Neves; Sofia Jorge; José António Lopes Journal: Ann Intensive Care Date: 2018-02-09 Impact factor: 6.925