Impact of Preoperative Anemia and Postoperative Hemoglobin Drop on the Incidence of Acute Kidney Injury and In-Hospital Mortality in Patients With Type B Acute Aortic Syndromes Undergoing Thoracic Endovascular Aortic Repair.
BACKGROUND
The impact of preoperative anemia and postoperative hemoglobin (Hb) drop on the incidence of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR) for type B acute aortic syndromes (AAS) as well as their prognostic value is unknown.


METHODS
This retrospective study included 144 patients with type B AAS undergoing TEVAR at our center. Preoperative anemia was classified as no/mild (Hb ≥ 12.0 g/dL in men; ≥11.3 g/dL in women), moderate (Hb 10.80-11.99 g/dL in men; 10.23-11.29 g/dL in women), and severe (<10.80 g/dL in men; <10.23 g/dL in women). Postoperative Hb drop was classified as mild (<2 g/dL), moderate (2-4 g/dL), and severe (>4 g/dL). End points of the study were postoperative AKI and in-hospital mortality.


RESULTS
Postoperative AKI was higher in the severe and moderate anemia groups than the no/mild anemia group (63.2%, 52.0%, and 31.0%, respectively, P = .01). In-hospital mortality and AKI were higher in patients with severe postoperative Hb drop (40.9% and 86.4%) than patients with moderate (6.9% and 36.2%) and mild (4.7% and 25.0%) postoperative Hb drop (both P < .001). Postoperative Hb drop (odds ratio [OR]:1.67, P = .036), postoperative Hb levels (OR: 0.57, P = .025), and mesenteric ischemia (OR: 4.65, P = .044) were identified as independent predictors of in-hospital mortality. Preoperative Hb (OR: 0.26, P = .001), postoperative Hb drop (OR: 4.34, P < .001), contrast medium (OR: 1.82, P = .004), and diabetes mellitus (OR: 3.79, P = .001) were independent predictors of AKI. At follow-up, anemia and postoperative Hb drop were not associated with increased mortality.


CONCLUSIONS
Preoperative Hb and postoperative Hb drop were significant risk factors for AKI. Postoperative Hb drop and Hb levels predicted in-hospital mortality.
1 Department of Cardiology, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.|2 University of Insubria, Varese, Italy.
Riccardo
R
Gorla
3 Department of Thoracic and Cardiovascular surgery, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
Konstantinos
K
Tsagakis
1 Department of Cardiology, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
Michael
M
Horacek
1 Department of Cardiology, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
Amir-Abbas
AA
Mahabadi
1 Department of Cardiology, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
Philipp
P
Kahlert
3 Department of Thoracic and Cardiovascular surgery, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
Heinz
H
Jakob
4 "Heart" Department, University Hospital, Salerno, Italy.
Eduardo
E
Bossone
5 Institute of Medical Informatics, Biometrics and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Raimund
R
Erbel
1 Department of Cardiology, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
Rolf Alexander
RA
Jánosi
D000208:Acute Disease; D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D015897:Comorbidity; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005858:Germany / Q000453:epidemiology; D006454:Hemoglobins / Q000378:metabolism*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D006454:Hemoglobins
acute aortic syndromes; acute kidney injury; anemia; thoracic endovascular aortic repair