Risk factors of acute kidney injury after surgery for acute type A aortic dissection: A systematic reveiw and meta-analysis
- VernacularTitle:急性 A 型主动脉夹层术后急性肾损伤危险因素的系统评价与 Meta 分析
- Author:
YU Jintian
1
;
CHEN Junshan
1
;
ZHANG Aiqin
2
Author Information
1. Department of Intensive Care Unit, Jinling Hospital Affiliated to Medical College of Nanjing University (Eastern Theater General Hospital), Nanjing, 210002, P.R.China
2. The Outpatient Department, Jinling Hospital Affiliated to Medical College of Nanjing University (Eastern Theater General Hospital), Nanjing, 210002, P.R.China
- Publication Type:Journal Article
- Keywords:
Acute aortic dissection;
acute kidney injury;
risk factors;
systematic review/meta-analysis
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2020;27(01):77-84
- CountryChina
- Language:Chinese
-
Abstract:
Objective To systematically evaluate the risk factors of acute kidney injury after surgery for acute type A aortic dissection. Methods We searched the CNKI, Wanfang Database, VIP, PubMed, Web of science, Cochrane Library (from inception to January 2019) to identify studies about the risk factors of acute kidney injury after surgery for acute type A aortic dissection. Quality of the included studies was evaluated by Kars-Ottawa scale. The meta-analysis was performed by RevMan 5.3 software. Results A total of 16 case-control studies were included involving 1 728 patients. The results of meta-analysis showed that gender (OR=1.58, 95% CI 1.31 to 1.89, P<0.001), body mass index (OR=1.05, 95% CI 0.66 to 1.45, P<0.001), hypertension (OR=1.58, 95% CI 1.10 to 2.26, P=0.010), smoking history (OR=1.71, 95% CI 1.12 to 2.61, P=0.010), preoperative serum creatinine level (OR=30.26, 95% CI 20.17 to 40.35, P<0.000 01), preoperative white blood cell (OR=1.73, 95% CI 0.26 to 3.20, P=0.020), extracorporeal circulation time (OR=25.60, 95% CI 21.13 to 30.08, P<0.000 01), aortic occlusion time (OR=13.24, 95% CI 10.27 to 16.22, P<0.001), deep hypothermic circulatory arrest (DHCA) time (OR=2.58, 95% CI 0.86 to 4.29, P=0.003), arch replacement (OR=2.31, 95% CI 1.31 to 4.07, P=0.004), intraoperative blood transfusion (OR=1.27, 95% CI 0.29 to 2.24, P=0.010), postoperative mean arterial pressure (OR=–2.41, 95% CI –4.59 to –0.24, P=0.030), reoperation due to postoperative hemorrhage (OR=4.19, 95% CI 2.04 to 8.63, P<0.001), postoperative acute respiratory insufficiency (OR=6.61, 95% CI 3.21 to 13.60, P<0.001), postoperative mechanical ventilation time (OR=48.51, 95% CI 21.94 to 75.09, P<0.001) were associated with acute kidney injury after surgery for acute type A aortic dissection. Conclusion Current evidence shows that gender, body mass index, hypertension, smoking history, preoperative serum creatinine level, preoperative white blood cell, extracorporeal circulation time, aortic occlusion time, deep hypothermic circulatory arrest (DHCA) time, arch replacement, intraoperative blood transfusion, postoperative mean arterial pressure, postoperative hemorrhage reoperation, postoperative acute respiratory insufficiency and postoperative mechanical ventilation time were risk factors for acute kidney injury after surgery for type A aortic dissection. Medical staff can strengthen perioperative management of patients with acute type A aortic dissection combined with the above factors, so as to reduce the incidence of acute kidney injury after operation and improve the clinical prognosis of patients.
