崔亚玲 1陈海生 1张春曦 1李彬 1张海 1叶东挺1
作者信息
- 1. 广州市第一人民医院(华南理工大学附属第二医院）心脏大血管外科(广东 广州 510180）
- 折叠
摘要
Abstract
Objective To explore the influences of preoperative serum creatinine(sCr)and estimated glomerular filtration rate(eGFR)on postoperative stage 3 acute kidney injury(AKI)or continuous renal replacement treatment(CRRT)in patients with acute Stanford type A aortic dissection(ATAAD).Methods From July 2017 to December 2022,143 ATAAD patients who underwent Bentall or ascending aortic replacement and total arch replacement and stented elephant trunk were retrospective analyzed.Data included preoperative sCr and eGFR,postoperative sCr,eGFR,urine volume,AKI and CRRT at 24 h and 48 h.Receiver operating characteristic(ROC)curve were used to analyze the influences of preoperative sCr and eGFR on stage 3 AKI and CRRT.Results Stage 3 AKI occurred in 27(18.9%)patients,including 14 patients who required CRRT.sCr was significantly higher in stage 3 AKI or CRRT group(AKI 3 vs AKI 0-2 group:t’=-2.722,P=0.011,CRRT vs non-CRRT group:t’=-2.184,P=0.048),and eGFR was significantly lower(AKI 3 vs AKI 0-2 group:t=4.585,P＜0.001,CRRT vs non-CRRT group:t=4.932,P＜0.001).Preoperative sCr could effectively predict postoperative stage 3 AKI(AUC 0.768,the best cut-off value was 123 μmol/L,sensitivity 67%,specificity 85%)and CRRT(AUC 0.848,the best cut-off value was 137.5 μmol/L,sensitivity 71%,specificity 88%).Preoperative eGFR could predict postoperative stage 3 AKI(AUC 0.761,the best cut-off value was 56.25mL/(min·1.73 m2),sensitivity 67%,specificity 83%)and CRRT(AUC 0.855,the best cut-off value was 47.6 mL/(min·1.73 m2),sensitivity 71%,specificity 87%).CRRT requirement significantly increased in patients with eGFR lower than 75.9 mL/(min·1.73 m2)who complicated with peripheral malperfusion.Conclusions Preoperative sCr and eGFR have significant influences on incidence of postoperative stage 3 AKI and CRRT.Postoperative stage 3 AKI significantly increase in patients with sCr more than 123 μmol/L or eGFR lower than 56.25mL/(min·1.73 m2).Postoperative CRRT significantly increase in patients with sCr more than 137.5 μmol/L,eGFR lower than 47.6mL/(min·1.73 m2),or peripheral malperfusion.关键词
Stanford A型主动脉夹层/血清肌酐/估测肾小球滤过率/急性肾损伤/连续性肾脏替代治疗Key words
acute Stanford type A aortic dissection/preoperative serum creatinine/estimated glomerular filtration rate/acute kidney injury/continuous renal replacement treatment
