Serum Cystatin C Predicts Postsurgical Acute Kidney Injury in Aortic Dissection

Abstract Background Studies reported a strong relationship between cystatin C and postsurgical acute kidney injury (AKI) following cardiac surgery. This study aims to establish the above relationship in acute type A aortic dissection (ATAAD) patients. Methods ATAAD patients receiving hemiarch replacement in combination with modified triple-branched stent-graft (MTBSG) implantation were recruited. The relationship between cystatin C and AKI, as well as in-hospital mortality, was analyzed. Results About 459 patients were enrolled. A total of 223 (48.6%) exhibited AKI and 71 (15.5%) exhibited severe AKI. AKI patients displayed elevated perioperative cystatin C levels. Upon adjustment of known AKI hazards, the logarithmically transformed presurgical cystatin C (odds ratio = 1.66 [95% confidence interval, 1.20–2.30], p = 0.010), postsurgical day 1 cystatin C (odds ratio = 2.61 [95% confidence interval, 1.70–4.13], p = 0.002), postsurgical day 2 cystatin C (odds ratio = 3.01 [95% confidence interval, 2.22–4.07], p = 0.001), and postsurgical day 3 cystatin C (odds ratio = 2.89 [95% confidence interval, 1.99–3.86], p = 0.009) were intricately linked to severe AKI. Moreover, these relationships remained even after adjusting for filtration reduction via alterations in serum creatinine (Δcreatinine) and urea nitrogen (Δurea nitrogen). Relative to the clinical model, cystatin C enhanced the risk discrimination and restratification of AKI. Conclusion For ATAAD patients, cystatin C greatly enhanced postsurgical AKI risk stratification. When dynamic cystatin C levels indicate a high risk of severe AKI, more aggressive monitoring should be performed to assess whether more intensive stent intervention is warranted to improve renal artery perfusion.