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. 2018 May;10(5):2590-2598.
doi: 10.21037/jtd.2018.05.47.

Independent risk factors for postoperative AKI and the impact of the AKI on 30-day postoperative outcomes in patients with type A acute aortic dissection: an updated meta-analysis and meta-regression

Jiayang Wang  1   2 , Wenyuan Yu  1 , Guangyao Zhai  3 , Nan Liu  2 , Lizhong Sun  1 , Junming Zhu  1
Affiliations

Independent risk factors for postoperative AKI and the impact of the AKI on 30-day postoperative outcomes in patients with type A acute aortic dissection: an updated meta-analysis and meta-regression

Jiayang Wang et al. J Thorac Dis. 2018 May.

Abstract

Background: This meta-analysis aims to investigate the effects of postoperative acute kidney injury (AKI) on 30-day postoperative outcomes and the independent risk factors for postoperative AKI in patients with type A acute aortic dissection (TAAD).

Methods: Relevant reports published between January 1, 2011 and May 31, 2017 were searched in multiple electronic literature databases. A total of seven eligible articles were included in the meta-analysis.

Results: Postoperative AKI was associated with 249% increase in 30-day postoperative mortality [odds ratio (OR): 3.49; 95% confidence interval (CI): 2.17-5.59; P<0.0001]. Subgroup analysis revealed that patients with stage II/III AKI showed 445% increase in 30-day postoperative mortality compared with the control group (OR: 5.45; 95% CI: 2.87-10.36; P<0.0001). Postoperative AKI was also associated with 143%, 432%, and 126% increase in the incidences of 30-day postoperative stroke, bleeding, and respiratory complications, respectively. Notably, high body mass index (BMI), advanced age, and perioperative sepsis were independent risk factors for postoperative AKI in patients with TAAD.

Conclusions: This meta-analysis firstly provided clinical evidence showing the adverse effects of postoperative AKI on 30-day postoperative outcomes in patients with TAAD and identified high BMI, advanced age, and perioperative sepsis as the independent risk factors for postoperative AKI. These findings suggest that preventive or therapeutic methods to effectively manage postoperative AKI may improve 30-day postoperative outcomes in patients with TAAD.

Keywords: 30-day mortality; Acute kidney injury (AKI); postoperative; risk factors; type A acute aortic dissection (TAAD).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Forest plots showing that postoperative AKI increased 30-day postoperative mortality. (A) Patients with postoperative AKI showed 249% increase in 30-day postoperative mortality compared with the control group; (B) the AKI stage II/III subgroup showed 445% increase in 30-day postoperative mortality compared with the control group. AKI, acute kidney injury.
Figure 3
Figure 3
Meta-regression revealed that postoperative AKI-associated increase in 30-day postoperative mortality was not influenced by different AKI definition used in the included studies (A) and publication year of the included studies (B). AKI, acute kidney injury.
Figure 4
Figure 4
Forest plots showing that compared with the control group, postoperative AKI was associated with 143%, 432%, and 126% increase in the incidences of 30-day postoperative stroke (A), bleeding (B), and respiratory complication (C), respectively.
Figure 5
Figure 5
BMI, advanced age, and perioperative sepsis were independent risk factors for postoperative AKI. AKI, acute kidney injury; BMI, body mass index.
See this image and copyright information in PMC

References

    1. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000;283:897-903. 10.1001/jama.283.7.897 - DOI - PubMed
    1. Hoff E, Eagle T, Pyeritz RE, et al. Pulse pressure and type A acute aortic dissection in-hospital outcomes (from the International Registry of Acute Aortic Dissection). Am J Cardiol 2014;113:1255-9. 10.1016/j.amjcard.2013.12.037 - DOI - PubMed
    1. Kosuge M, Uchida K, Imoto K, et al. Frequency and implication of ST-T abnormalities on hospital admission electrocardiograms in patients with type A acute aortic dissection. Am J Cardiol 2013;112:424-9. 10.1016/j.amjcard.2013.03.050 - DOI - PubMed
    1. Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part II: therapeutic management and follow-up. Circulation 2003;108:772-8. 10.1161/01.CIR.0000087400.48663.19 - DOI - PubMed
    1. Sasabuchi Y, Kimura N, Shiotsuka J, et al. Long-Term Survival in Patients With Acute Kidney Injury After Acute Type A Aortic Dissection Repair. Ann Thorac Surg 2016;102:2003-9. 10.1016/j.athoracsur.2016.05.006 - DOI - PubMed

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