Risk factors for stage 3 AKI after acute Stanford type A aortic dissection repair

BACKGROUND: To explore the risk factors for developing severe acute kidney injury (stage 3 acute kidney injury) after acute type A aortic dissection (ATAAD) surgery. METHODS: From January 2017 to December 2022, 163 ATAAD patients who underwent Bentall or ascending aortic replacement combined with total arch replacement and elephant trunk repair were retrospective analyzed.Postoperative stage 3 AKI was diagnosed according to the KDIGO criteria. Multivariate logistic regression analyses were applied to identify risk factors for postoperative stage 3 AKI. RESULTS: Stage 3 AKI occurred in 35 patients(21.5%),with a significantly higher in-hospital mortality than AKI0-2 group (RR=4.88, chi-square value=11.557, P=0.001). Preoperative serum creatinine (sCr), preoperative eGFR, chronic kidney disease history, long-term smoking history, surgical method, cardiopulmonary bypass time, aortic cross-clamp time, postoperative low cardiac output, and postoperative stroke were significantly associated with stage 3 AKI (P<0.05). Multivariate Logistic regression analysis identified that preoperative creatinine (OR=1.023, 95%CI: 1.013-1.034, P=0.000), surgical method (OR=0.089, 95%CI: 0.025-0.319, P=0.000) and postoperative low cardiac output (OR=15.214, 95%CI: 1.765-131.135, P=0.013) are independent risk factors for AKI3. Preoperative sCr could effectively predict postoperative AKI3 (AUC=0.747; cutoff value: 123.5μmol/L; sensitivity: 63%; specificity: 83%). CONCLUSION: Postoperative stage 3 AKI was significantly associated with in-hospital mortality after ATAAD surgery. Preoperative sCr, surgical method, and postoperative low cardiac output are independent risk factors for postoperative stage 3 AKI.The incidence of stage 3 AKI is significantly higher in patients with preoperative sCr >123.5μmol/L.