Risk Factors and Outcomes of Acute Kidney Injury after Type A Aortic Dissection Surgery at A Tertiary Care Hospital

Authors

  • Thavat Chanchayanon Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla 90110, Thailand
  • Jutarat Tanasansuttiporn Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla 90110, Thailand
  • Garnphipak Heerungeeragon Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla 90110, Thailand.
  • Maliwan Oofuwong Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla 90110, Thailand.

DOI:

https://doi.org/10.31584/jhsmr.2021846

Keywords:

acute kidney injury, aortic dissection surgery, risk factor

Abstract

Objective: This study aimed to determine the risk factors predisposing to postoperative acute kidney injury (AKI) after type A aortic dissection repair; regarding patient-related, surgery-related and anesthesia-related factors.

Material and Methods: A retrospective cohort study was conducted in patients who underwent type A aortic dissection repair under cardiopulmonary bypass (CPB), during the periods from January 2008 and December 2019. Patient-related, surgery-related and anesthesia-related factors were evaluated for association with AKI. AKI was defined by the Kidney Disease: Improving Global Outcomes criteria. The outcomes and mortality of AKI were also investigated.

Results: Included were 95 patients, and the incidence of AKI was 65.3%. The 30-day mortality resulted only in the AKI group (14.9%). From multivariate logistic regression analysis, receiving intraoperative cryoprecipitate (odd ratio; OR 14.18; 95% confidence interval (CI), 3.27-61.5) and PRC transfusion (OR 1.001; 95% CI, 1.0005-1.002) in ICU were the risk factors for AKI. The protective factors were: higher preoperative serum bicarbonate levels (OR 0.83; 95% CI, 0.70- 0.99), higher volume of urine output during CPB (OR 0.71; 95% CI, 0.55-0.91) and higher immediate postoperative mean arterial pressure (OR 0.95; 95% CI, 0.92-0.98). Thirty-day mortality was significantly higher in the AKI group (14.5% vs 0%; p-value=0.025), and 15.0% of patients required renal replacement therapy.

Conclusion: The higher level of three factors including preoperative serum bicarbonate levels (>23 mmol/l), volume of urine output during CPB and immediate postoperative mean arterial pressure (>81 mmHg) are likely to be the protective factors of AKI.

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References

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Published

2022-07-22

How to Cite

1.
Chanchayanon T, Tanasansuttiporn J, Heerungeeragon G, Oofuwong M. Risk Factors and Outcomes of Acute Kidney Injury after Type A Aortic Dissection Surgery at A Tertiary Care Hospital. J Health Sci Med Res [Internet]. 2022 Jul. 22 [cited 2023 Jan. 28];40(4):379-90. Available from: https://he01.tci-thaijo.org/index.php/jhsmr/article/view/257726

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