title: Impact of Acute Kidney Injury on Early to Long-Term Outcomes in Patients Who Underwent Surgery for Type A Acute Aortic Dissection.
abstract: Acute kidney injury (AKI) is relatively common after cardiothoracic surgery for type A acute aortic dissection (TA-AAD) and increases mortality. We investigated the incidence and risk factors for AKI in patients with TA-AAD and its impact on their outcomes. The records of 375 consecutive patients who underwent surgical treatment for TA-AAD from October 2007 to March 2013 were analyzed retrospectively. We defined AKI using the Kidney Disease Improving Global Outcomes criteria, which are based on serum creatinine concentration or glomerular filtration rate. We used Kaplan-Meier methods and multivariate Cox proportional hazards regression to assess the impact of AKI on both mortality and major adverse cardiovascular and cerebrovascular events. We also examined the association between risk factors and AKI using logistic regression modeling. Postoperative AKI was observed in 165 patients (44.0%). The overall 30-day and mid- to long-term mortality was 1.6% and 8.8%, respectively. Mortality and major adverse cardiovascular and cerebrovascular events correlated significantly with the severity of AKI, and multivariate analysis showed that AKI stage 3 (the most sever stage) was an independent risk factor for mortality (hazard ratio 6.83, 95% confidence interval 2.52 to 18.52) after adjustment for important confounding factors. Extracorporeal circulation time, body mass index, perioperative peak serum C-reactive protein concentration, renal malperfusion, and perioperative sepsis were found to be risk factors for AKI. In conclusion, AKI was common in patients who underwent surgery for type A acute aortic dissection. The severity of AKI strongly influences patient outcomes, so it should be recognized promptly and treated aggressively when possible.
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ko
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan. Electronic address: mhigashi@shi.heart.or.jp.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Higashitani
authors.affiliation: Department of Cardiology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Sato
authors.affiliation: Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Yukari
authors.initials: Y
authors.lastname: Uemura
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Togo
authors.initials: T
authors.lastname: Norimatsu
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Mahara
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Takamisawa
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Seki
authors.affiliation: Department of Anesthesia, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Shimizu
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tobaru
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Haruo
authors.initials: H
authors.lastname: Aramoto
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Iguchi
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukui
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Nagayama
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Morimasa
authors.initials: M
authors.lastname: Takayama
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sumiyoshi
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Hitonobu
authors.initials: H
authors.lastname: Tomoike
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors