Impact of acute kidney injury on in-hospital outcomes in patients with DeBakey type III acute aortic dissection.
The relation between the incidence and severity of acute kidney injury (AKI) and clinical outcomes remains unclear in patients with DeBakey type III acute aortic dissection (AAD). We retrospectively assessed 56 patients admitted to our hospital for type III AAD within 48 hours of the onset of symptoms. The presence of AKI was identified, and its severity was staged on the basis of changes in serum creatinine (SCr) levels within 7 days after admission. We investigated the relations between AKI and clinical presentations, in-hospital complications, and predischarge renal function; AKI was observed in 20 patients (36%). After adjusting for age, gender, and body mass index, the incidence of AKI was associated with a history of hypertension, electrocardiographic ST-T changes, DeBakey type IIIb, and SCr level on admission. Maximum white blood cell count and serum C-reactive protein level were higher in patients with AKI than in those without AKI. AKI was associated with a greater incidence of in-hospital complications (70% vs 39%, p = 0.03) and higher SCr levels at discharge (1.1 [range 1.0 to 2.0] vs 0.9 [range 0.7 to 1.0] mg/dl, p = 0.0001). These associations were more pronounced in patients with relatively severe AKI. Multivariate analysis revealed that SCr level on admission and DeBakey type IIIb with renal artery involvement were major predictors of AKI. In conclusion, renal function on admission and renal artery involvement were significant risk factors for AKI, which was associated with poor outcomes and enhanced inflammatory response during hospitalization in patients with type III AAD.
Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan. Electronic address: ttakahashi@saichu.jp.
Toshiyuki
T
Takahashi
Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
Tasuku
T
Hasegawa
Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
Naoki
N
Hirata
Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
Ayaka
A
Endo
Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
Yu
Y
Yamasaki
Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
Kenki
K
Ashida
Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
Yusuke
Y
Kabeya
Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
Susumu
S
Nakagawa
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D000368:Aged; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D003404:Creatinine / Q000097:blood; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends
D003404:Creatinine