Clinical study of perioperative acute kidney injury due to different types of acute aortic dissection

Objective To compare the risk factors and clinical characteristics of acute kidney injury (AKI) in patients with Stanford A/B acute aortic dissection (AAD). Methods Between January 1, 2019 and December 31, 2021, 464 hospitalized AAD patients were divided into two types of TAAAAD (n=176) and TBAAD (n=288) according to the imaging results of computed tomography angiography (CTA). And they were assigned into two groups of AKI and non-AKI according to the KDIGO criteria. Preoperative, intraoperative and postoperative data were compared between two groups. Independent risk factors of AKI were screened by binary Logistic regression. And receiver operating characteristic (ROC) curve was plotted for assessing the prognostic value of each risk factor for the development of AKI. Renal functions of AAD-AKI patients were recorded upon discharge.Results The incidence of AKI was 83.5%(147/176) in TAAAD patients and 41%(118/288) in TBAAD patients. Multifactorial Logistic regression analysis revealed that duration of extracorporeal circulation, initial postoperative creatinine, duration of mechanical ventilation and perioperative use of vasopressors were independent risk factors for AKI in TAAAD patients (P<0.05). Receiver operating characteristic (ROC) curve indicated that TAAAD-AKI had the greatest correlation with initial postoperative creatinine (AUC:0.857, P=0.001). Poor renal perfusion, initial creatinine on admission, initial postoperative creatinine and perioperative use of collaterals diuretics were independent risk factors for AKI in TBAAD patients (P<0.05). ROC curve indicated that TBAAD-AKI had the greatest correlation with initial creatinine at admission (AUC:0.777, P=0.004). As for renal functions at discharge, only half of them had a complete recovery of renal function at discharge and hospital mortality was higher in TAAAD-AKI patients. Conclusion Independent risk factors differ between TAAAD-AKI and TBAAD-AKI. Prevention and treatment of AKI also vary with different factors. For nearly half of patients with an incomplete recovery of renal function at discharge, long-term follow-ups should be performed.