Introduction
Materials and methods
Study design and participants
Definition of AKI following OTAS and postoperative outcomes
Surgical details
Statistical analysis
Results
Patient characteristics
Incidence of AKI after open thoracic aortic surgery
Postoperative AKI in the overall cohort
No AKI | AKI | P1 Value* | P2 Value# | |||
---|---|---|---|---|---|---|
Stage 1 | Stage 2 | Stage 3 | ||||
Patient population (n) | 169 | 153 | 49 | 28 | ||
Demographic data | ||||||
Age (y) | 52.0 (18.0) | 54.0 (16.5) | 50.0 (13.0) | 41.5 (17.5) | 0.9 | 0.004 |
Sex, male (n) | 112 (66.3%) | 116 (75.8%) | 34 (69.4%) | 21 (75.0%) | 0.08 | 0.3 |
Height (cm) | 170.0 (13.0) | 170.0 (8.5) | 170.0 (14.0) | 169.0 (10.0) | 0.7 | 1.0 |
Weight (kg) | 70.0 (16.0) | 72.0 (18.0) | 74.0 (24.0) | 75.0 (20.0) | 0.002 | 0.02 |
BMI (kg/m2) | 24.6 (5.1) | 25.7 (5.8) | 25.2 (4.9) | 27.4 (5.8) | 0.003 | 0.009 |
Medical history | ||||||
Diabetes (n) | 4 (2.4%) | 4 (2.6%) | 3 (6.1%) | 1 (3.6%) | 0.5 | 0.6 |
Hypertension (n) | 74 (43.8%) | 85 (55.6%) | 34 (69.4%) | 23 (82.1%) | < 0.001 | < 0.001 |
Chronic obstructive pulmonary disease (n) | 4 (2.4%) | 6 (3.9%) | 1 (2.0%) | 0 (0.0%) | 0.7 | 0.6 |
Previous myocardial infarction (n) | 1 (0.6%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0.2 | 0.7 |
Peripheral vascular disease (n) | 13 (7.7%) | 11 (7.2%) | 5 (10.2%) | 1 (3.6%) | 0.9 | 0.8 |
Smoking (n) | 57 (33.7%) | 59 (38.6%) | 19 (38.8%) | 12 (42.9%) | 0.3 | 0.7 |
Preoperative laboratory tests | ||||||
Platelet (109/L) | 197.0 (71.0) | 186.5 (71.8) | 199.0 (65.5) | 166.5 (68.3) | 0.006 | 0.01 |
Lymphocyte (109/L) | 1.63 (0.74) | 1.58 (0.90) | 1.18 (0.72) | 1.48 (0.90) | 0.004 | 0.001 |
Monocyte (109/L) | 0.44 (0.30) | 0.51 (0.40) | 0.79 (0.78) | 0.91 (0.70) | < 0.001 | < 0.001 |
Neutrophil (109/L) | 4.22 (2.95) | 4.86 (4.30) | 7.51 (5.64) | 10.1 (5.3) | < 0.001 | < 0.001 |
Hyperlipidemia (n) | 55 (34.4%) | 44 (31.0%) | 7 (14.9%) | 10 (43.5%) | 0.2 | 0.04 |
Retinol binding protein (mg/L) | 35.7 (16.2) | 37.8 (18.7) | 26.4 (24.7) | 37.3 (22.5) | 0.7 | 0.007 |
Urinary protein | ||||||
+/− | 17 (11.6%) | 25 (18.8%) | 10 (23.8%) | 4 (20.0%) | 0.05 | 0.2 |
+ | 14 (9.5%) | 20 (15.0%) | 11 (26.2%) | 8 (40.0%) | 0.01 | 0.005 |
++ | 1 (0.7%) | 2 (1.5%) | 2 (4.8%) | 1 (5.0%) | 0.2 | 0.3 |
INR | 1.04 (0.12) | 1.04 (0.1) | 1.09 (0.15) | 1.10 (0.2) | 0.05 | 0.02 |
Preoperative renal function | ||||||
Preoperative SCr (μmol/L) | 70.4 (21.79) | 73.6 (23.1) | 66.0 (26.3) | 76.0 (45.7) | 0.3 | 0.07 |
> 106 (n) | 11 (6.5%) | 13 (8.5%) | 4 (8.2%) | 8 (28.6%) | 0.1 | 0.002 |
eGFR(mL/min/1.73 m2) | 99.8 (22.0) | 97.2 (21.2) | 103.4 (18.2) | 94.4 (39.5) | 0.2 | 0.08 |
Preoperative cardiovascular status | ||||||
Marfan syndrome (n) | 14 (8.3%) | 3 (2.0%) | 1 (2.0%) | 1 (3.6%) | 0.005 | 0.04 |
Aortic dissection (n) | 56 (33.1%) | 71 (46.4%) | 36 (73.5%) | 24 (85.7%) | < 0.001 | < 0.001 |
Stanford type-A aortic dissection (n) | 53 (31.4%) | 71 (46.4%) | 34 (69.4%) | 24 (85.7%) | < 0.001 | < 0.001 |
Intraoperative blood product use | ||||||
Erythrocytes (u) | 2.0 (2.0) | 4.0 (3.9) | 4.0 (6.0) | 4.0 (4.5) | 0.001 | < 0.001 |
Fresh frozen plasma (ml) | 400.0 (200.0) | 400.0 (150.0) | 400.0 (375.0) | 600.0 (500.0) | 0.06 | 0.002 |
Platelets (u) | 1.0 (0.0) | 1.0 (1.0) | 1.0 (1.0) | 2.0 (1.0) | 0.002 | < 0.001 |
Surgical details | ||||||
Involving the aortic arch (n) | 79 (46.7%) | 97 (63.4%) | 38 (77.6%) | 26 (92.9%) | < 0.001 | < 0.001 |
Involving the descending aorta (n) | 43 (25.4%) | 60 (39.2%) | 33 (67.3%) | 24 (85.7%) | < 0.001 | < 0.001 |
CPB duration(min) | 133.0 (75.5) | 165.0 (79.0) | 201.0 (67.5) | 220.0 (52.0) | < 0.001 | < 0.001 |
DHCA or MHCA (n) | 58 (34.3%) | 76 (49.7%) | 34 (69.4%) | 25 (89.3%) | < 0.001 | < 0.001 |
Aortic cross-clamp time (min) | 86.0 (27.0) | 90.0 (31.0) | 96.0 (32.0) | 113.0 (32.0) | < 0.001 | < 0.001 |
Operation time (h) | 6.0 (2.0) | 7.0 (2.0) | 8.5 (2.0) | 9.0 (2.5) | < 0.001 | < 0.001 |
Combined surgery | ||||||
Valvular surgery (n) | 94 (55.6%) | 67 (43.8%) | 10 (20.4%) | 3 (10.7%) | < 0.001 | < 0.001 |
Outcomes | ||||||
Renal replacement therapy (n) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 12 (42.9%) | 0.003 | < 0.001 |
Length of ICU stay (day) | 3.0 (2.0) | 4.0 (2.5) | 5.0 (4.0) | 10.5 (11.0) | < 0.001 | < 0.001 |
> 7 d (n) | 19 (11.2%) | 20 (13.1%) | 17 (34.7%) | 23 (82.1%) | < 0.001 | < 0.001 |
Intubation time (h) | 15.0 (9.0) | 17.0 (27.5) | 38.0 (72.5) | 136.0 (110.3) | < 0.001 | < 0.001 |
> 5 d (n) | 4 (2.4%) | 5 (3.3%) | 6 (12.2%) | 17 (60.7%) | < 0.001 | < 0.001 |
Stroke (n) | 0 (0.0%) | 4 (2.6%) | 0 (0.0%) | 2 (7.1%) | 0.04 | 0.01 |
Redo surgery (n) | 4 (2.4%) | 6 (3.9%) | 6 (12.2%) | 6 (21.4%) | 0.02 | < 0.001 |
In-hospital mortality (n) | 2 (1.2%) | 1 (0.7%) | 1 (2.1%) | 8 (28.6%) | 0.07 | < 0.001 |
Postoperative AKI in the patients with AAS
Postoperative AKI in the patients without AAS
Risk factors of postoperative AKI after open thoracic aortic surgery
Risk factors of postoperative AKI for the overall cohort
Variable | Odds Ratio | 95% Confidence Interval | P Value |
---|---|---|---|
Age (y) | 1.01 | 0.99–1.02 | 0.6 |
Sex, male | 1.48 | 0.95–2.28 | 0.08 |
Weight | 1.02 | 1.01–1.04 | 0.006 |
Hypertension | 2.07 | 1.38–3.10 | < 0.001 |
Preoperative platelet | 1.00 | 0.99–1.00 | 0.006 |
Preoperative lymphocyte | 0.64 | 0.46–0.88 | 0.007 |
Preoperative monocyte | 3.76 | 2.02–7.00 | < 0.001 |
Preoperative neutrophil | 1.16 | 1.08–1.23 | < 0.001 |
NLR | 1.17 | 1.10–1.25 | < 0.001 |
LMR | 0.88 | 0.81–0.96 | 0.003 |
Preoperative urinary protein + or ++ | 2.43 | 1.30–4.53 | 0.005 |
Marfan syndrome | 0.25 | 0.09–0.70 | 0.008 |
Aortic dissection | 2.67 | 1.77–4.04 | < 0.001 |
Standford type-A aortic dissection | 2.80 | 1.84–4.24 | < 0.001 |
Intraoperative fresh frozen plasma use | 1.00 | 1.00–1.00 | 0.01 |
Involving the aortic arch | 2.66 | 1.76–4.02 | < 0.001 |
Involving the descending aorta | 3.03 | 1.97–4.67 | < 0.001 |
CPB duration | 1.01 | 1.01–1.02 | < 0.001 |
DHCA or MHCA | 2.72 | 1.80–4.11 | < 0.001 |
Aortic cross-clamp time | 1.02 | 1.01–1.02 | < 0.001 |
Operation time | 1.63 | 1.41–1.89 | < 0.001 |
Combined valvular surgery | 0.43 | 0.28–0.64 | < 0.001 |
Risk factors of postoperative AKI for the patients with AAS
No AKI | AKI Stage | P1 Value* | P2 Value# | |||
---|---|---|---|---|---|---|
1 | 2 | 3 | ||||
Patient population (n) | 56 | 71 | 36 | 24 | ||
Demographic data | ||||||
Age (y) | 48.0 (16.5) | 48.0 (15.0) | 48.0 (13.5) | 41.0 (8.3) | 0.2 | 0.07 |
Sex, male (n) | 31 (55.4%) | 52 (73.2%) | 24 (66.7%) | 18 (75.0%) | 0.03 | 0.1 |
Height (cm) | 170.0 (12.8) | 171.0 (7.0) | 172.0 (10.5) | 170.0 (13.0) | 0.4 | 0.5 |
Weight (kg) | 71.9 ± 10.2 | 78.0 ± 12.6 | 77.1 ± 14.4 | 77.8 ± 13.4 | 0.003 | 0.07 |
BMI (kg/m2) | 25.5 ± 2.8 | 25.7 ± 5.6 | 26.4 ± 3.9 | 28.2 ± 3.7 | 0.3 | 0.2 |
Medical history | ||||||
Diabetes (n) | 2 (3.6%) | 1 (1.4%) | 2 (5.6%) | 1 (4.2%) | 0.9 | 0.7 |
Hypertension (n) | 38 (67.9%) | 46 (64.8%) | 30 (83.3%) | 23 (95.8%) | 0.3 | 0.009 |
Chronic obstructive pulmonary disease (n) | 1 (1.8%) | 1 (1.4%) | 0 (0.0%) | 0 (0.0%) | 0.5 | 0.8 |
Peripheral vascular disease (n) | 4 (7.1%) | 5 (7.0%) | 4 (11.1%) | 1 (4.2%) | 0.9 | 0.8 |
Smoking (n) | 17 (30.4%) | 21 (29.6%) | 13 (36.1%) | 9 (37.5%) | 0.7 | 0.8 |
Preoperative laboratory tests | ||||||
Platelet (109/L) | 195.5 (106.0) | 191.0 (82.0) | 191.0 (83.3) | 177.0 (65.5) | 0.1 | 0.2 |
Lymphocyte (109/L) | 1.39 (0.75) | 1.24 (0.81) | 1.13 (0.59) | 1.41 (0.99) | 0.01 | 0.03 |
Monocyte (109/L) | 0.70 (0.56) | 0.67 (0.60) | 0.89 (0.63) | 0.92 (0.82) | 0.03 | 0.03 |
Neutrophil (109/L) | 7.39 ± 3.60 | 7.76 ± 3.41 | 8.97 ± 3.33 | 10.52 ± 3.76 | 0.04 | 0.001 |
Hyperlipidemia (n) | 14 (25.0%) | 16 (22.5%) | 3 (8.3%) | 9 (37.5%) | 0.6 | 0.02 |
Retinol binding protein (mg/L) | 27.6 (24.1) | 27.9 (17.1) | 21.2 (16.4) | 37.3 (25.2) | 0.7 | 0.02 |
Preoperative renal function | ||||||
Dissection involving renal artery (n) | 4 (7.1%) | 6 (8.5%) | 4 (11.1%) | 5 (20.8%) | 0.4 | 0.3 |
Preoperative SCr (μmol/L) | 65.5 (31.0) | 75.0 (24.4) | 68.5 (36.2) | 81.1 (47.9) | 0.2 | 0.2 |
> 106 (n) | 6 (10.7%) | 10 (14.1%) | 4 (11.1%) | 7 (29.2%) | 0.3 | 0.2 |
Surgical details | ||||||
Involving the aortic arch (n) | 50 (89.3%) | 66 (93.0%) | 35 (97.2%) | 24 (100.0%) | 0.1 | 0.2 |
Involving the descending aorta (n) | 43 (76.8%) | 59 (83.1%) | 33 (91.7%) | 23 (95.8%) | 0.06 | 0.1 |
CPB duration (min) | 188.0 (38.8) | 201.0 (44.0) | 222.0 (51.8) | 235.0 (60.0) | < 0.001 | < 0.001 |
DHCA or MHCA (n) | 48 (85.7%) | 65 (91.5%) | 34 (94.4%) | 23 (95.8%) | 0.1 | 0.4 |
Aortic cross-clamp time (min) | 94.5 (21.8) | 99.0 (31.0) | 96.0 (32.5) | 110.0 (29.0) | 0.02 | 0.02 |
Operation time (h) | 7.0 (1.5) | 8.0 (1.5) | 8.5 (1.9) | 9.0 (2.5) | < 0.001 | < 0.001 |
Combined surgery | ||||||
CABG (n) | 1 (1.8%) | 2 (2.8%) | 0 (0.0%) | 3 (12.5%) | 0.5 | 0.04 |
Valvular surgery (n) | 8 (14.3%) | 7 (9.9%) | 1 (2.8%) | 0 (0.0%) | 0.07 | 0.1 |
Outcomes | ||||||
Renal replacement therapy (n) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 11 (45.8%) | 0.03 | < 0.001 |
Length of ICU stay (day) | 5.0 (3.8) | 5.0 (2.0) | 5.0 (4.0) | 12.0 (11.5) | 0.02 | < 0.001 |
> 7 d (n) | 17 (30.4%) | 16 (22.5%) | 13 (36.1%) | 22 (91.7%) | 0.3 | < 0.001 |
Intubation time (h) | 19.0 (20.0) | 24.0 (32.0) | 40.5 (75.8) | 147.5 (81.0) | < 0.001 | < 0.001 |
> 5 d (n) | 4 (7.1%) | 4 (5.6%) | 5 (13.9%) | 17 (70.8%) | 0.03 | < 0.001 |
Redo surgery (n) | 2 (3.6%) | 2 (2.8%) | 5 (13.9%) | 6 (25.0%) | 0.1 | 0.002 |
In-hospital mortality (n) | 1 (1.8%) | 1 (1.4%) | 0 (0.0%) | 7 (29.2%) | 0.2 | < 0.001 |
Variable | Odds Ratio | 95% Confidence Interval | P Value |
---|---|---|---|
Age (y) | 0.98 | 0.95–1.01 | 0.2 |
Sex, male | 2.05 | 1.07–3.92 | 0.03 |
Weight | 1.04 | 1.01–1.07 | 0.009 |
Preoperative platelet | 1.00 | 0.99–1.00 | 0.06 |
Preoperative lymphocyte | 0.61 | 0.37–1.01 | 0.05 |
Preoperative monocyte | 2.42 | 1.10–5.36 | 0.03 |
Preoperative neutrophil | 1.10 | 1.01–1.21 | 0.04 |
NLR | 1.16 | 1.06–1.28 | 0.002 |
LMR | 0.77 | 0.64–0.93 | 0.007 |
Preoperative NYHA class III or IV | 0.39 | 0.14–1.03 | 0.06 |
Involving the descending aorta | 2.17 | 0.97–4.89 | 0.06 |
CPB duration | 1.02 | 1.01–1.03 | < 0.001 |
DHCA or MHCA | 2.26 | 0.82–6.20 | 0.1 |
Aortic cross-clamp time | 1.02 | 1.00–1.04 | 0.01 |
Operation time | 1.63 | 1.26–2.10 | < 0.001 |
Combined valvular surgery | 0.39 | 0.14–1.1 | 0.08 |
Risk factors of postoperative AKI for the patients without AAS
No AKI | AKI Stage | P1 Value* | P2 Value# | |||
---|---|---|---|---|---|---|
1 | 2 | 3 | ||||
Patient population (n) | 113 | 82 | 13 | 4 | ||
Demographic data | ||||||
Age (y) | 53.0 (17.5) | 60.0 (11.0) | 52.0 (14.0) | 55.0 (19.5) | 0.002 | 0.01 |
Sex, male (n) | 81 (71.7%) | 64 (78.0%) | 10 (76.9%) | 3 (75.0%) | 0.3 | 0.8 |
Height (cm) | 170.0 (14.0) | 168.0 (10.5) | 165.0 (15.0) | 166.5 (4.5) | 0.1 | 0.3 |
Weight (kg) | 67.0 (16.0) | 69.1 (15.6) | 66.0 (15.0) | 62.0 (17.0) | 0.6 | 0.2 |
BMI (kg/m2) | 24.2 (5.3) | 25.0 (5.7) | 22.9 (5.0) | 22.8 (5.6) | 0.09 | 0.09 |
Medical history | ||||||
Diabetes (n) | 2 (1.8%) | 3 (3.7%) | 1 (7.7%) | 0 (0.0%) | 0.3 | 0.6 |
Hypertension (n) | 36 (31.9%) | 39 (47.6%) | 4 (30.8%) | 0 (0.0%) | 0.08 | 0.05 |
Chronic obstructive pulmonary disease (n) | 3 (2.7%) | 5 (6.1%) | 1 (7.7%) | 0 (0.0%) | 0.2 | 0.6 |
Previous myocardial infarction (n) | 1 (0.9%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0.3 | 0.8 |
Peripheral vascular disease (n) | 9 (8.0%) | 6 (7.3%) | 1 (7.7%) | 0 (0.0%) | 0.8 | 0.9 |
Smoking (n) | 40 (35.4%) | 38 (46.3%) | 6 (46.2%) | 3 (75.0%) | 0.08 | 0.2 |
Preoperative laboratory tests | ||||||
Platelet (109/L) | 197.0 (57.5) | 183.0 (58.0) | 203.0 (54.5) | 137.5 (109.3) | 0.03 | 0.09 |
Preoperative renal function | ||||||
eGFR(mL/min/1.73 m2) | 99.8 (16.1) | 95.9 (18.1) | 101.7 (16.4) | 97.2 (37.6) | 0.04 | 0.02 |
Preoperative cardiovascular status | ||||||
Previous cardiovascular surgery (n) | 2 (1.8%) | 1 (1.2%) | 0 (0.0%) | 1 (25.0%) | 0.9 | 0.008 |
LVEF (%) | 58.0 (8.0) | 60.0 (4.5) | 52.5 (17.8) | 59.0 (11.8) | 0.2 | 0.08 |
Marfan syndrome (n) | 11 (9.7%) | 2 (2.4%) | 1 (7.7%) | 0 (0.0%) | 0.05 | 0.2 |
Intraoperative blood product use | ||||||
Erythrocytes (u) | 2.0 (3.0) | 2.0 (4.0) | 3.0 (3.0) | 4.0 (6.0) | 0.2 | 0.07 |
Fresh frozen plasma (ml) | 400.0 (0.0) | 400.0 (0.0) | 400.0 (300.0) | 650.0 (450.0) | 0.2 | 0.02 |
Platelets (u) | 1.0 (1.0) | 1.0 (1.0) | 1.0 (1.0) | 2.0 (0.8) | 0.5 | 0.004 |
Surgical details | ||||||
Involving the aortic arch (n) | 29 (25.7%) | 31 (37.8%) | 3 (23.1%) | 2 (50.0%) | 0.09 | 0.2 |
Involving the descending aorta (n) | 0 (0.0%) | 1 (1.2%) | 0 (0.0%) | 1 (25.0%) | 0.1 | < 0.001 |
CPB duration(min) | 117.5 (43.0) | 131.0 (50.5) | 137.0 (52.5) | 187.5 (34.8) | 0.005 | 0.003 |
DHCA or MHCA (n) | 10 (8.8%) | 11 (13.4%) | 0 (0.0%) | 2 (50.0%) | 0.3 | 0.03 |
Aortic cross-clamp time (min) | 81.0 (27.8) | 83.0 (31.3) | 94.0 (32.5) | 122.0 (42.8) | 0.08 | 0.04 |
Operation time (h) | 5.0 (1.0) | 6.0 (1.5) | 7.0 (2.3) | 8.5 (2.5) | < 0.001 | < 0.001 |
Combined surgery | ||||||
CABG (n) | 8 (7.1%) | 11 (13.4%) | 2 (15.4%) | 1 (25.0%) | 0.09 | 0.3 |
Outcomes | ||||||
Renal replacement therapy (n) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 1 (25.0%) | 0.3 | < 0.001 |
ICU length of stay (day) | 3.0 (1.0) | 3.0 (2.0) | 5.0 (5.0) | 4.0 (7.5) | < 0.001 | < 0.001 |
> 7 d (n) | 2 (1.8%) | 4 (4.9%) | 4 (30.8%) | 1 (25.0%) | 0.02 | < 0.001 |
Intubation time (h) | 13.0 (8.0) | 14.0 (9.0) | 20.0 (28.5) | 28.5 (28.5) | 0.03 | 0.001 |
> 5 d (n) | 0 (0.0%) | 1 (1.2%) | 1 (7.7%) | 0 (0.0%) | 0.1 | 0.06 |
In-hospital mortality (n) | 1 (0.9%) | 0 (0.0%) | 1 (7.7%) | 1 (25.0%) | 0.5 | < 0.001 |
Variable | Odds Ratio | 95% Confidence Interval | P Value |
---|---|---|---|
Age (y) | 1.05 | 1.02–1.08 | < 0.001 |
Sex, male | 1.38 | 0.74–2.59 | 0.3 |
Hypertension | 1.64 | 0.94–2.88 | 0.08 |
Smoking | 1.65 | 0.95–2.86 | 0.08 |
Preoperative platelet | 0.99 | 0.99–1.00 | 0.02 |
PLR | 0.99 | 0.99–1.00 | 0.05 |
Preoperative eGFR | 0.98 | 0.97–1.00 | 0.06 |
Marfan syndrome | 0.29 | 0.08–1.07 | 0.06 |
Involving the aortic arch | 1.66 | 0.92–2.98 | 0.09 |
CPB duration | 1.01 | 1.00–1.02 | 0.01 |
Operation time | 1.56 | 1.22–1.99 | < 0.001 |