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Risk factors analysis of acute kidney injury following open thoracic aortic surgery in the patients with or without acute aortic syndrome: a retrospective study.

ABSTRACT: BACKGROUND:The acute kidney injury (AKI) remains a frequent complication following open thoracic aortic surgery (OTAS) and worsens the postoperative prognosis. It remains unclear that whether the predictors of AKI following OTAS are different in the patients with or without acute aortic syndrome (AAS). METHODS:Preoperative and intraoperative variables were compared between the patients with or without AKI, and were further analyzed for identifying the potential predictors of postoperative AKI. Subgroup analysis was conducted in the patients with or without AAS, respectively. RESULTS:AKI after OTAS occurred in 57.6% of the overall cohort, 70.1% of the patients with AAS and 46.7% of the patients without AAS. In the multivariate analysis, history of hypertension (OR 1.011, 95% CI: [1.001-1.022], p?=?0.04), preoperative platelet (OR 0.995, 95% CI: [0.991-0.999], p?=?0.006) and operation time (OR 1.572, 95% CI: [1.355-1.823], p?

SUBMITTER: Ma X

PROVIDER: S-EPMC7412815 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Risk factors analysis of acute kidney injury following open thoracic aortic surgery in the patients with or without acute aortic syndrome: a retrospective study.

Ma Xiaochun X Li Jinzhang J Yun Yan Y Zhao Diming D Chen Shanghao S Ma Huibo H Wang Zhengjun Z Zhang Haizhou H Zou Chengwei C Cui Yuqi Y

Journal of cardiothoracic surgery 20200807 1

<h4>Background</h4>The acute kidney injury (AKI) remains a frequent complication following open thoracic aortic surgery (OTAS) and worsens the postoperative prognosis. It remains unclear that whether the predictors of AKI following OTAS are different in the patients with or without acute aortic syndrome (AAS).<h4>Methods</h4>Preoperative and intraoperative variables were compared between the patients with or without AKI, and were further analyzed for identifying the potential predictors of posto ...[more]

PMID: 32767994

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Project description:BackgroundAcute kidney injury (AKI) is a prevalent complication following acute type A aortic dissection (ATAAD) surgery and is closely associated with unfavorable prognostic outcomes. Hence, the development of a robust and efficient diagnostic approach to identify high-risk patients is of paramount importance.MethodsWe conducted a prospective study involving 328 patients who underwent ATAAD surgery at our institution, comprising three distinct cohorts. In addition, 52 patients undergoing alternative cardiopulmonary surgeries and 37 healthy individuals were enrolled as control groups. Employing proteomic analysis, we initially identified plasma proteins potentially linked to AKI occurrence within the plasma proteomic cohort. Subsequent validation was performed in an independent cohort. Utilizing predictors derived from multivariate logistic regression analysis, a nomogram was meticulously formulated and its efficacy was validated in the model construction cohort.ResultsProteomics revealed significant elevation of plasma levels of S100A8/A9, pentraxin 3 (PTX3), and chitinase 3-like 1 (CHI3L1) immediately post-surgery in patients who developed ATAAD surgery-associated AKI (ASA-AKI). Receiver operating characteristic (ROC) curves demonstrated impressive predictive performance of S100A8/A9, PTX3, and CHI3L1 at 0 h post-surgery, yielding area under the curve (AUC) values of 0.823, 0.786, and 0.803, respectively, for ASA-AKI prediction. Furthermore, our findings exhibited positive correlations between plasma levels of S100A8/A9, PTX3, CHI3L1, and urinary neutrophil gelatinase-associated lipocalin (NGAL) at 0 h post-surgery, along with correlations between plasma S100A8/A9, CHI3L1 levels, and the Cleveland Clinic score. A logistic regression model incorporating plasma S100A8/A9, PTX3, CHI3L1 levels, urinary NGAL levels, and the Cleveland Clinic score facilitated the construction of a predictive nomogram for ASA-AKI. This nomogram demonstrated robust discriminative ability, achieving an AUC of 0.963 in the model construction cohort.ConclusionsOur study underscored the augmentation of plasma S100A8/A9, PTX3, and CHI3L1 levels immediately post-surgery in patients developing ASA-AKI. The incorporation of these three biomarkers, in conjunction with the Cleveland Clinic score and NGAL, into a nomogram demonstrated commendable predictive efficacy. This presents a practical tool for identifying patients at an elevated risk of AKI following ATAAD surgery.

Dataset Information

Risk factors analysis of acute kidney injury following open thoracic aortic surgery in the patients with or without acute aortic syndrome: a retrospective study.

Publications

Risk factors analysis of acute kidney injury following open thoracic aortic surgery in the patients with or without acute aortic syndrome: a retrospective study.

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