Incidence and risk factors of acute renal injury after Stanford type A aortic dissections

XU Xiao; LI Xiaodong; WEN Jing; NING Jiaolin

doi:10.16016/j.2097-0927.202504009

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Incidence and risk factors of acute renal injury after Stanford type A aortic dissections

Clinical Medicine | 更新时间：2025-07-25

- Incidence and risk factors of acute renal injury after Stanford type A aortic dissections
- Journal of Army Medical University Vol. 47, Issue 14, Pages: 1642-1651(2025)
- 作者机构：
  
  陆军军医大学（第三军医大学）第一附属医院麻醉科，重庆
- 作者简介：
  
  NING Jiaolin， E-mail： njiaolin1976@126.com
- 基金信息：
  
  the General Program of National Natural Science Foundation of China(82270095)
- DOI：10.16016/j.2097-0927.202504009
  CLC： R181.23;R543.16;R692.02
- Received：01 April 2025，
  
  Revised：24 June 2025，
  
  Published：30 July 2025
- 稿件说明：
移动端阅览
徐小，李小东，文静，等.Stanford A型主动脉夹层术后急性肾功能损伤的发生情况及其危险因素分析［J］.陆军军医大学学报，2025，47（14）：1642-1651.DOI：10.16016/j.2097-0927.202504009.

XU X，LI X D，WEN J，et al.Incidence and risk factors of acute renal injury after Stanford type A aortic dissections［J］.J Army Med Univ，2025，47（14）：1642-1651.DOI：10.16016/j.2097-0927.202504009.
徐小，李小东，文静，等.Stanford A型主动脉夹层术后急性肾功能损伤的发生情况及其危险因素分析［J］.陆军军医大学学报，2025，47（14）：1642-1651.DOI：10.16016/j.2097-0927.202504009. DOI：

XU X，LI X D，WEN J，et al.Incidence and risk factors of acute renal injury after Stanford type A aortic dissections［J］.J Army Med Univ，2025，47（14）：1642-1651.DOI：10.16016/j.2097-0927.202504009. DOI：

摘要

目的

探索Stanford A型主动脉夹层（type A aortic dissection，TAAD）手术患者术后急性肾功能损伤（acute kidney injury，AKI）的发生情况，分析其危险因素并建立相关预测模型。

方法

本研究为回顾性病例对照研究，纳入2016年1月至2024年6月接受TAAD手术治疗的138例患者的临床资料，依据改善全球肾脏病预后组织定义诊断术后1周内AKI，分为AKI组（

=95）和非AKI组（

=43）。采用单因素及多因素Logistic回归分析围术期危险因素，并构建列线图进行预测和分析受试者工作特征曲线（ROC）评估预测效能。

结果

TAAD患者术后AKI发生率为68.84%，其中3期AKI为51.58%（49例），38.95%（37例）需持续肾脏替代治疗；术后AKI组监护室天数、拔管时间及放弃继续治疗率显著高于非AKI组（

0.001）。多因素分析表明，术后第1天单核细胞计数（

=3.521）、术前肌酐（

=1.019）是AKI的独立危险因素，术后尿酸水平（

=1.005）与其相关，而术中尿量（

=0.739）和术后第1天球蛋白水平（

=0.781）为保护性因素；基于上述危险因素构建AKI风险预测模型，ROC曲线下面积为0.866，敏感性为0.811，特异性为0.791。

结论

通过优化TAAD患者术中尿量、调控术后炎症反应、加强营养支持可减少术后AKI的发生。AKI风险预测模型对临床早期识别TAAD术后AKI的高危患者具有一定意义。

Abstract

Objective‍　‍To explore the occurrence of acute kidney injury (AKI) in patients with Stanford type A aortic dissection (TAAD) after surgical treatment

analyze the risk factors

and construct a prediction model. Methods‍　‍A retrospective case-control study was conducted on 138 TAAD patients undergoing surgical treatment in our hospital from January 2016 to June 2024. After Kidney Disease Improving Global Outcomes (KDIGO) criteria was performed within 1 week after surgery

they were divided into AKI (

=95) and non-AKI (

=43) groups. Univariate and multivariate logistic regression analyses were performed to identify the perioperative risk factors.

Then a nomogram model were constructed

and receiver operating characteristic (ROC) curve was plotted to analyze its predictive efficacy. Results‍　‍The incidence of postoperative AKI was 68.84% (95 cases) in the TAAD patients

including 51.58% (49 cases) of stage 3 AKI and 38.95% (37 cases) requiring continuous renal replacement therapy. The length of ICU stay

time to extubation

and abandonment of treatment were significantly higher in the AKI group than the non-AKI group (

0.001). Multifactorial analysis showed that the monocyte count on postoperative day 1 (

=3.521) and preoperative creatinine level (

=1.019) were independent risk factors for AKI

postoperative uric acid level (

=1.005) was correlated with AKI

and intraoperative urine volume (

=0.739) and globulin level at 1 d postoperatively (

=0.781) were protective factors. The area under the ROC curve of the constructed model was 0.866

with a sensitivity of 0.811 and a specificity of 0.791. Conclusion‍　‍Postoperative AKI occurrence can be reduced in TAAD patients by optimizing the intraoperative urine output

modulating the postoperative inflammatory response

and strengthening nutritional support. Our prediction model for AKI risk is of significance for early clinical identification of high-risk patients in TAAD patients after surgical treatment.

关键词

Keywords

references

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