title: Impact of acute kidney injury on one-year survival after surgery for aortic dissection.
abstract: BACKGROUND
  Surgical treatment is an option for both type A aortic dissection and complicated type B aortic dissection. Acute kidney injury (AKI) influences the disease course after surgery. Our hypothesis was that AKI should be an important prognostic factor for aortic dissection after surgical treatment.
  
  
  METHODS
  Between July 2005 and October 2010, 268 patients (mean age 53 ± 14 years; range, 16 to 88) underwent open surgery for aortic dissection. We reviewed the clinical presentations, surgical variables, and postoperative outcomes to identify the risk factors of death. The 256 patients were divided into groups, with and without AKI, within 24 hours after operation according to the RIFLE (acronym for risk, injury, failure, loss, end stage) criteria.
  
  
  RESULTS
  The in-hospital mortality rate was 17.9%, the 1-year mortality rate was 18.7%, and the major adverse cardiac events rate within 1 year was 29.9%. In multivariate analysis, patients more than 70 years of age (hazard ratio [HR] 2.390, p = 0.029), cardiogenic shock (HR 2.895, p = 0.005), preoperative ventilator use (HR 4.137, p = 0.018), operation at midnight (HR 2.295, p = 0.028), longer bypass time (HR 1.007, p < 0.001), and AKI (HR 2.552, p = 0.041) were clinical predictors of mortality. Kaplan-Meier analysis showed that the survival rate was strongly correlated with the severity of AKI by the RIFLE criteria. The independent predictors of AKI included hypertension (odds ratio 2.340, p = 0.027), sepsis (odds ratio 2.594, p = 0.043), and lower limb malperfusion (odds ratio 4.558, p = 0.022).
  
  
  CONCLUSIONS
  Our study provides outcomes of postoperative aortic dissection. We found that AKI was a predictor of 1-year mortality by using the RIFLE criteria. Factors associated with increased 1-year mortality and AKI should be taken into consideration for surgery and postoperative care.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
authors.forename: Hsing-Shan
authors.initials: HS
authors.lastname: Tsai
authors.forename: Feng-Chun
authors.initials: FC
authors.lastname: Tsai
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Chen
authors.forename: Lung-Sheng
authors.initials: LS
authors.lastname: Wu
authors.forename: Shao-Wei
authors.initials: SW
authors.lastname: Chen
authors.forename: Jaw-Ji
authors.initials: JJ
authors.lastname: Chu
authors.forename: Pyng-Jing
authors.initials: PJ
authors.lastname: Lin
authors.forename: Pao-Hsien
authors.initials: PH
authors.lastname: Chu
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult