Risk factors of acute kidney injury after surgery for acute type A aortic dissection: A systematic reveiw and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YU Jintian ¹ , CHEN Junshan ¹ ,  ZHANG Aiqin ²

1. Department of Intensive Care Unit, Jinling Hospital Affiliated to Medical College of Nanjing University (Eastern Theater General Hospital), Nanjing, 210002, P.R.China;
2. The Outpatient Department, Jinling Hospital Affiliated to Medical College of Nanjing University (Eastern Theater General Hospital), Nanjing, 210002, P.R.China;

Corresponding author：

ZHANG Aiqin, Email: aq09z@126.com

Keywords：

Acute aortic dissection; acute kidney injury; risk factors; systematic review/meta-analysis

DOI：

10.7507/1007-4848.201903006

Video：

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Objective To systematically evaluate the risk factors of acute kidney injury after surgery for acute type A aortic dissection.Methods We searched the CNKI, Wanfang Database, VIP, PubMed, Web of science, Cochrane Library (from inception to January 2019) to identify studies about the risk factors of acute kidney injury after surgery for acute type A aortic dissection. Quality of the included studies was evaluated by Kars-Ottawa scale. The meta-analysis was performed by RevMan 5.3 software.Results A total of 16 case-control studies were included involving 1 728 patients. The results of meta-analysis showed that gender (OR=1.58, 95% CI 1.31 to 1.89, P<0.001), body mass index (OR=1.05, 95% CI 0.66 to 1.45, P<0.001), hypertension (OR=1.58, 95% CI 1.10 to 2.26, P=0.010), smoking history (OR=1.71, 95% CI 1.12 to 2.61, P=0.010), preoperative serum creatinine level (OR=30.26, 95% CI 20.17 to 40.35, P<0.000 01), preoperative white blood cell (OR=1.73, 95% CI 0.26 to 3.20, P=0.020), extracorporeal circulation time (OR=25.60, 95% CI 21.13 to 30.08, P<0.000 01), aortic occlusion time (OR=13.24, 95% CI 10.27 to 16.22, P<0.001), deep hypothermic circulatory arrest (DHCA) time (OR=2.58, 95% CI 0.86 to 4.29, P=0.003), arch replacement (OR=2.31, 95% CI 1.31 to 4.07, P=0.004), intraoperative blood transfusion (OR=1.27, 95% CI 0.29 to 2.24, P=0.010), postoperative mean arterial pressure (OR=–2.41, 95% CI –4.59 to –0.24, P=0.030), reoperation due to postoperative hemorrhage (OR=4.19, 95% CI 2.04 to 8.63, P<0.001), postoperative acute respiratory insufficiency (OR=6.61, 95% CI 3.21 to 13.60, P<0.001), postoperative mechanical ventilation time (OR=48.51, 95% CI 21.94 to 75.09, P<0.001) were associated with acute kidney injury after surgery for acute type A aortic dissection.Conclusion Current evidence shows that gender, body mass index, hypertension, smoking history, preoperative serum creatinine level, preoperative white blood cell, extracorporeal circulation time, aortic occlusion time, deep hypothermic circulatory arrest (DHCA) time, arch replacement, intraoperative blood transfusion, postoperative mean arterial pressure, postoperative hemorrhage reoperation, postoperative acute respiratory insufficiency and postoperative mechanical ventilation time were risk factors for acute kidney injury after surgery for type A aortic dissection. Medical staff can strengthen perioperative management of patients with acute type A aortic dissection combined with the above factors, so as to reduce the incidence of acute kidney injury after operation and improve the clinical prognosis of patients.

Citation： YU Jintian, CHEN Junshan, ZHANG Aiqin. Risk factors of acute kidney injury after surgery for acute type A aortic dissection: A systematic reveiw and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(1): 77-84. doi: 10.7507/1007-4848.201903006 Copy

1.	Baumann F, Makaloski V, Diehm N. Aortic aneurysms and aortic dissection: epidemiology, pathophysiology and diagnostics. Internist (Berl), 2013, 54(5): 535-542.
2.	Rylski B, Hoffmann I, Beyersdorf F, et al. Acute aortic dissection type A: age-related management and outcomes reported in the German Registry for Acute Aortic Dissection Type A (GERAADA) of over 2000 patients. Ann Surg, 2014, 259(3): 598-604.
3.	Kim W, Lee JH, Kim E, et al. Can we really predict postoperative acute kidney injury after aortic surgery? Diagnostic accuracy of risk scores using gray zone approach. Thorac Cardiovasc Surg, 2016, 64(4): 281-289.
4.	Zhao H, Pan X, Gong Z, et al. Risk factors for acute kidney injury in overweight patients with acute type A aortic dissection: a retrospective study. J Thorac Dis, 2015, 7(8): 1385-1390.
5.	Luo S, Ding H, Luo J, et al. Risk factors and early outcomes of acute renal injury after thoracic aortic endograft repair for type B aortic dissection. Ther Clin Risk Manag, 2017, 13: 1023-1029.
6.	Ko T, Higashitani M, Sato A, et al. Impact of acute kidney injury on early to long-term outcomes in patients who underwent surgery for type A acute aortic dissection. Am J Cardiol, 2015, 116(3): 463-468.
7.	Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury after thoracic aortic surgery for acute dissection. Ann Thorac Surg, 2012, 94(3): 766-771.
8.	Qiu Z, Chen L, Cao H, et al. Analysis of risk factors for acute kidney injury after ascending aortic replacement combined with open placement of triple-branched stent graft in type A aortic dissection: a new technique versus the traditional method in a single Chinese center. Med Sci Monit, 2015, 21: 674-680.
9.	Sansone F, Morgante A, Ceresa F, et al. Prognostic implications of acute renal failure after surgery for type A acute aortic dissection. Aorta (Stamford), 2015, 3(3): 91-97.
10.	尹广, 陈欣. 急性肾损伤的定义及其临床诊断新标准. 西部医学, 2013, 25(12): 1916-1918.
11.	Sasabuchi Y, Kimura N, Shiotsuka J, et al. Long-term survival in patients with acute kidney injury after acute type a aortic dissection Repair. Ann Thorac Surg, 2016, 102(6): 2003-2009.
12.	Wu HB, Qin H, Ma WG, et al. Can renal resistive index predict acute kidney injury after acute type A aortic dissection repair. Ann Thorac Surg, 2017, 104(5): 1583-1589.
13.	Qin H, Wu H, Chen Y, et al. Early Detection of postoperative acute kidney injury in acute stanford type A aortic dissection with doppler renal resistive index. J Ultrasound Med, 2017, 36(10): 2105-2111.
14.	宋先荣, 韩雪萍. Stanford A型主动脉夹层术后急性肾损伤的影响因素. 中华胸心血管外科杂志, 2012, 28(10): 603-604, 613.
15.	王树伟, 苏存华, 阎岩, 等. 急性A型主动脉夹层术后肾衰竭的危险因素分析. 第二军医大学学报, 2014, 35(2): 136-140.
16.	曾嵘, 范瑞新, 范小平, 等. 急性A型主动脉夹层患者术后急性肾损伤的危险因素. 中华胸心血管外科杂志, 2014, 30(1): 30-32, 37.
17.	阮彩霞, 尚蔚, 侯晓彤, 等. C反应蛋白与急性A型主动脉夹层术后急性肾损伤的相关性. 中华胸心血管外科杂志, 2014, 30(12): 741-744.
18.	尚蔚, 马敏, 阮彩霞, 等. 急性主动脉夹层孙氏手术后急性肾损伤临床研究. 中华胸心血管外科杂志, 2016, 32(7): 407-410.
19.	潘旭东, 赵宏磊, 白涛, 等. 超重急性A型主动脉夹层患者孙氏术后急性肾损伤的危险因素分析. 中华胸心血管外科杂志, 2017, 33(5): 295-299.
20.	石海鹏, 王秀哲, 杨晓静, 等. 急性Stanford A型主动脉夹层患者术后并发急性肾损伤危险因素的回顾性研究. 中华重症医学电子杂志(网络版), 2017, 3(4): 275-279.
21.	生伟, 栾天, 池一凡, 等. 急性Stanford A型主动脉夹层术后急性肾功能损伤的危险因素分析. 中国胸心血管外科临床杂志, 2019, 26(1): 67-72.
22.	贡鸣, 李磊, 李嘉晨, 等. 急性A型主动脉夹层患者肾损伤与超重的相关性研究. 心肺血管病杂志, 2019, 38(1): 30-35, 51.
23.	叶楠, 张燕, 程虹, 等. 成人心外科手术后急性肾损伤的评分预警系统创建. 中国胸心血管外科临床杂志, 2013, 20(4): 396-401.
24.	刘洋, 严中亚. 二尖瓣主动脉瓣双瓣置换术后急性肾损伤发生的相关危险因素分析. 中华临床医师杂志(电子版), 2015, 9(11): 2127-2130.
25.	Hodeify R, Megyesi J, Tarcsafalvi A, et al. Gender differences control the susceptibility to ER stress-induced acute kidney injury. Am J Physiol Renal Physiol, 2013, 304(7): F875-F882.
26.	Sullivan KE, Byrne JS, Hudson A, et a1. The effect of obesity on acute kidney injury after cardiac surgery. J Thorac Cardiovase Surg, 2015, 150(6): 1622-1628.
27.	韦莉萍. 成年人体外循环心脏手术后急性肾损伤相关危险因素分析. 广西: 广西医科大学, 2017.
28.	Kim WH, Park MH, Kim HJ, et al. Potentially modifiable risk factors for acute kidney injury after surgery on the thoracic aorta: a propensity score matched case-control study. Medicine (Baltimore), 2015, 94(2): 273-281.
29.	Ejerblad E, Fored CM, Lindblad P, et al. Association between smoking and chronic renal failure in a nationwide population-based case-control study. J Am Soc Nephrol, 2004, 15(8): 2178-2185.
30.	王肇, 高长青, 肖苍松, 等. 主动脉夹层术后早期急性肾损伤的危险因素分析. 解放军医学院学报, 2014, 35(7): 692-695.
31.	Takahashi T, Hasegawa T, Hirata N, et al. Impact of acute kidney injury on in-hospital outcomes in patients with DeBakey type Ⅲ acute aortic dissection. Am J Cardiol, 2014, 113(11): 1904-1910.
32.	Kuehl H, Eggebrecht H, Boes T, et al. Detection of inflammation in patients with acute aortic syndrome: comparison of FDG-PET/CT imaging and serological markers of inflammation. Heart, 2008, 94(11): 1472-1477.
33.	Wojtaszek E, Głogowski T. Cardiac surgery associated acute kidney injury. Wiad Lek, 2015, 68(4 Pt 2): 668-670.
34.	Bonventre JV, Yang L. Cellular pathophysiology of ischemic acute kidney injury. J Clin Invest, 2011, 121(11): 4210-4221.
35.	陈玉新. 心脏直视手术围术期急性肾损伤影响因素分析. 河南: 郑州大学, 2017.
36.	Nuis RJ, Rodes CJ, Sinning JM, et al. Blood transfusion and the risk of acute kidney injury after transcatheter aortic valve implantation. Circ Cardiovasc Interv, 2012, 5(5): 680-688.
37.	Karkouti K. Transfusion and risk of acute kidney injury in cardiae surgery. Br J Anaesth, 2012, 109(Suppl l): i29-i38.
38.	万辛, 陈鑫, 谢祥成, 等. 心脏手术相关性急性肾损伤发病率及其危险因素分析. 南京医科大学学报(自然科学版), 2015, 35(12): 1746-1749.
39.	Fischer UM, Weissenberger WK, Warters RD, et al. Impact of cardio pulmonary bypass management on postcardiac surgery renal function. Perfusion, 2002, 17(6): 401-406.
40.	Petek BJ, Bravo PE, Kim F, et al. Incidence and risk factors for postcontrast acute kidney injury in survivors of sudden cardiac arrest. Ann Emerg Med, 2016, 67(4): 469-476.
41.	Karkouti K, Wijeysundera DN, Yau TM, et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation, 2009, 119(4): 495-502.
42.	Wang Y, Xue S, Zhu H. Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery. J Cardiothorac Surg, 2013, 8: 118-123.
43.	van den Akker JP, Egal M, Groeneveld AB. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysis. Crit Care, 2013, 17(3): R98-R107.

1. Baumann F, Makaloski V, Diehm N. Aortic aneurysms and aortic dissection: epidemiology, pathophysiology and diagnostics. Internist (Berl), 2013, 54(5): 535-542.
2. Rylski B, Hoffmann I, Beyersdorf F, et al. Acute aortic dissection type A: age-related management and outcomes reported in the German Registry for Acute Aortic Dissection Type A (GERAADA) of over 2000 patients. Ann Surg, 2014, 259(3): 598-604.
3. Kim W, Lee JH, Kim E, et al. Can we really predict postoperative acute kidney injury after aortic surgery? Diagnostic accuracy of risk scores using gray zone approach. Thorac Cardiovasc Surg, 2016, 64(4): 281-289.
4. Zhao H, Pan X, Gong Z, et al. Risk factors for acute kidney injury in overweight patients with acute type A aortic dissection: a retrospective study. J Thorac Dis, 2015, 7(8): 1385-1390.
5. Luo S, Ding H, Luo J, et al. Risk factors and early outcomes of acute renal injury after thoracic aortic endograft repair for type B aortic dissection. Ther Clin Risk Manag, 2017, 13: 1023-1029.
6. Ko T, Higashitani M, Sato A, et al. Impact of acute kidney injury on early to long-term outcomes in patients who underwent surgery for type A acute aortic dissection. Am J Cardiol, 2015, 116(3): 463-468.
7. Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury after thoracic aortic surgery for acute dissection. Ann Thorac Surg, 2012, 94(3): 766-771.
8. Qiu Z, Chen L, Cao H, et al. Analysis of risk factors for acute kidney injury after ascending aortic replacement combined with open placement of triple-branched stent graft in type A aortic dissection: a new technique versus the traditional method in a single Chinese center. Med Sci Monit, 2015, 21: 674-680.
9. Sansone F, Morgante A, Ceresa F, et al. Prognostic implications of acute renal failure after surgery for type A acute aortic dissection. Aorta (Stamford), 2015, 3(3): 91-97.
10. 尹广, 陈欣. 急性肾损伤的定义及其临床诊断新标准. 西部医学, 2013, 25(12): 1916-1918.
11. Sasabuchi Y, Kimura N, Shiotsuka J, et al. Long-term survival in patients with acute kidney injury after acute type a aortic dissection Repair. Ann Thorac Surg, 2016, 102(6): 2003-2009.
12. Wu HB, Qin H, Ma WG, et al. Can renal resistive index predict acute kidney injury after acute type A aortic dissection repair. Ann Thorac Surg, 2017, 104(5): 1583-1589.
13. Qin H, Wu H, Chen Y, et al. Early Detection of postoperative acute kidney injury in acute stanford type A aortic dissection with doppler renal resistive index. J Ultrasound Med, 2017, 36(10): 2105-2111.
14. 宋先荣, 韩雪萍. Stanford A型主动脉夹层术后急性肾损伤的影响因素. 中华胸心血管外科杂志, 2012, 28(10): 603-604, 613.
15. 王树伟, 苏存华, 阎岩, 等. 急性A型主动脉夹层术后肾衰竭的危险因素分析. 第二军医大学学报, 2014, 35(2): 136-140.
16. 曾嵘, 范瑞新, 范小平, 等. 急性A型主动脉夹层患者术后急性肾损伤的危险因素. 中华胸心血管外科杂志, 2014, 30(1): 30-32, 37.
17. 阮彩霞, 尚蔚, 侯晓彤, 等. C反应蛋白与急性A型主动脉夹层术后急性肾损伤的相关性. 中华胸心血管外科杂志, 2014, 30(12): 741-744.
18. 尚蔚, 马敏, 阮彩霞, 等. 急性主动脉夹层孙氏手术后急性肾损伤临床研究. 中华胸心血管外科杂志, 2016, 32(7): 407-410.
19. 潘旭东, 赵宏磊, 白涛, 等. 超重急性A型主动脉夹层患者孙氏术后急性肾损伤的危险因素分析. 中华胸心血管外科杂志, 2017, 33(5): 295-299.
20. 石海鹏, 王秀哲, 杨晓静, 等. 急性Stanford A型主动脉夹层患者术后并发急性肾损伤危险因素的回顾性研究. 中华重症医学电子杂志(网络版), 2017, 3(4): 275-279.
21. 生伟, 栾天, 池一凡, 等. 急性Stanford A型主动脉夹层术后急性肾功能损伤的危险因素分析. 中国胸心血管外科临床杂志, 2019, 26(1): 67-72.
22. 贡鸣, 李磊, 李嘉晨, 等. 急性A型主动脉夹层患者肾损伤与超重的相关性研究. 心肺血管病杂志, 2019, 38(1): 30-35, 51.
23. 叶楠, 张燕, 程虹, 等. 成人心外科手术后急性肾损伤的评分预警系统创建. 中国胸心血管外科临床杂志, 2013, 20(4): 396-401.
24. 刘洋, 严中亚. 二尖瓣主动脉瓣双瓣置换术后急性肾损伤发生的相关危险因素分析. 中华临床医师杂志(电子版), 2015, 9(11): 2127-2130.
25. Hodeify R, Megyesi J, Tarcsafalvi A, et al. Gender differences control the susceptibility to ER stress-induced acute kidney injury. Am J Physiol Renal Physiol, 2013, 304(7): F875-F882.
26. Sullivan KE, Byrne JS, Hudson A, et a1. The effect of obesity on acute kidney injury after cardiac surgery. J Thorac Cardiovase Surg, 2015, 150(6): 1622-1628.
27. 韦莉萍. 成年人体外循环心脏手术后急性肾损伤相关危险因素分析. 广西: 广西医科大学, 2017.
28. Kim WH, Park MH, Kim HJ, et al. Potentially modifiable risk factors for acute kidney injury after surgery on the thoracic aorta: a propensity score matched case-control study. Medicine (Baltimore), 2015, 94(2): 273-281.
29. Ejerblad E, Fored CM, Lindblad P, et al. Association between smoking and chronic renal failure in a nationwide population-based case-control study. J Am Soc Nephrol, 2004, 15(8): 2178-2185.
30. 王肇, 高长青, 肖苍松, 等. 主动脉夹层术后早期急性肾损伤的危险因素分析. 解放军医学院学报, 2014, 35(7): 692-695.
31. Takahashi T, Hasegawa T, Hirata N, et al. Impact of acute kidney injury on in-hospital outcomes in patients with DeBakey type Ⅲ acute aortic dissection. Am J Cardiol, 2014, 113(11): 1904-1910.
32. Kuehl H, Eggebrecht H, Boes T, et al. Detection of inflammation in patients with acute aortic syndrome: comparison of FDG-PET/CT imaging and serological markers of inflammation. Heart, 2008, 94(11): 1472-1477.
33. Wojtaszek E, Głogowski T. Cardiac surgery associated acute kidney injury. Wiad Lek, 2015, 68(4 Pt 2): 668-670.
34. Bonventre JV, Yang L. Cellular pathophysiology of ischemic acute kidney injury. J Clin Invest, 2011, 121(11): 4210-4221.
35. 陈玉新. 心脏直视手术围术期急性肾损伤影响因素分析. 河南: 郑州大学, 2017.
36. Nuis RJ, Rodes CJ, Sinning JM, et al. Blood transfusion and the risk of acute kidney injury after transcatheter aortic valve implantation. Circ Cardiovasc Interv, 2012, 5(5): 680-688.
37. Karkouti K. Transfusion and risk of acute kidney injury in cardiae surgery. Br J Anaesth, 2012, 109(Suppl l): i29-i38.
38. 万辛, 陈鑫, 谢祥成, 等. 心脏手术相关性急性肾损伤发病率及其危险因素分析. 南京医科大学学报(自然科学版), 2015, 35(12): 1746-1749.
39. Fischer UM, Weissenberger WK, Warters RD, et al. Impact of cardio pulmonary bypass management on postcardiac surgery renal function. Perfusion, 2002, 17(6): 401-406.
40. Petek BJ, Bravo PE, Kim F, et al. Incidence and risk factors for postcontrast acute kidney injury in survivors of sudden cardiac arrest. Ann Emerg Med, 2016, 67(4): 469-476.
41. Karkouti K, Wijeysundera DN, Yau TM, et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation, 2009, 119(4): 495-502.
42. Wang Y, Xue S, Zhu H. Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery. J Cardiothorac Surg, 2013, 8: 118-123.
43. van den Akker JP, Egal M, Groeneveld AB. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysis. Crit Care, 2013, 17(3): R98-R107.

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Risk factors of acute kidney injury after surgery for acute type A aortic dissection: A systematic reveiw and meta-analysis

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