title: Predictors and in-hospital outcomes of preoperative acute kidney injury in patients with type A acute aortic dissection.
abstract: BACKGROUND
  Acute kidney injury (AKI) is common after surgery for acute aortic dissection (AAD) and increases in-hospital and long-term mortality. However, few data exist on the clinical and prognostic relevance of early preoperative AKI in patients with type A AAD. We aimed to determine the incidence and predictors of preoperative AKI and the impact of AKI on in-hospital outcomes in patients with type A AAD.
  
  
  METHODS
  From May 2009 to June 2014, we retrospectively enrolled 178 patients admitted to our hospital within 48 h from symptom onset and receiving open surgery for type A AAD. The patients were divided into no AKI and AKI groups and staged with AKI severity according to the KDIGO criteria before surgery.
  
  
  RESULTS
  AKI occurred in 41 patients (23.0%). The incidence of in-hospital complications was significantly higher in patients with preoperative AKI compared to no AKI (41.5%vs.9.5%,P< 0.001), including renal infarction (7.3%vs.0,P= 0.012), and it increased with AKI severity (Ptrend< 0.001). Patients with AKI had higher in-hospital mortality compared with patients without AKI, although no significant difference was found (14.6%vs.5.1%,P= 0.079). Multivariate analysis indicated that male gender, diastolic blood pressure on admission and bilateral renal artery involvement were independent predictors of preoperative AKI in patients with type A AAD.
  
  
  CONCLUSIONS
  Early AKI before surgery was common in patients with type A AAD, and was associated with increased in-hospital complications. Male gender, diastolic blood pressure on admission and bilateral renal artery involvement were major predictors for preoperative AKI.
authors: Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Xiao
authors: X
authors: Wang
authors: Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Hong-Mei
authors: HM
authors: Ren
authors: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
authors: Chun-Yan
authors: CY
authors: Hu
authors: Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Bin
authors: B
authors: Que
authors: Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Hui
authors: H
authors: Ai
authors: Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Chun-Mei
authors: CM
authors: Wang
authors: Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Li-Zhong
authors: LZ
authors: Sun
authors: Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Shao-Ping
authors: SP
authors: Nie
keywords: Acute kidney injury; Aortic dissection; Outcomes