Acute renal failure following operation in patients with acute type A aortic dissection: An analysis of risk factors / 第二军医大学学报

ABSTRACT

Objective To identify the risk factors of acute renal failure following operation in patients with acute type A aortic dissection (AAAD). Methods The clinical data of 266 consecutive patients undergoing operation for AAAD between Jan. 2002 and Mar. 2013 were retrospectively analyzed. The patients were divided into two groups according to the presence of postoperative acute renal failure. The general data were compared between the two groups. Univariate and multivariate conditional logistic regression analysiswere used to determine the independent risk factors of postoperative acute renal failure. Results Eighteen (6. 77%) patients had acute renal failure in our study. The incidence rates of preoperative cardiac dysfunction (NYHA II-IV) (P = 0. 024), renal insufficiency (P = 0. 002), cardiopulmonary bypass time (CPBT)≥190 min (P = 0. 000), aortic cross-clamp time≥90 min (P = 0. 015), postoperative re-operation for bleeding (P = 0. 004), brain damage (P = 0. 013), acute respiratory dysfunction (P = 0. 000) and perioperative erythrocyte transfusions (P = 0. 015) were significantly different between the two groups preoperatively. Multivariate conditional logistic regression analysis showed that preoperative renal insufficiency (0R=6.978, 95% Cl 1.874-25.997), CPBT≥190 min (0R= 5. 663, 95% Cl 1.621-19.781), perioperative erythrocyte transfusions (0R=1.071, 95% CI 1. 030-1. 113)and postoperative acute respiratory dysfunction (0R= 4. 853, 95% Cl 1. 467-16. 053)were independent risk factors for postoperative acute renal failure. Conclusion Renal failure is a severe complication caused by many risk factors after operation in AAAD patients. The patients should be monitored closely early after operation; the risks of acute renal failure should be assessed and individualized intervention should be given to improve hospital mortality and prognosis.