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Moderate to Severe Acute Kidney Injury Leads to Worse Outcomes in Complex Thoracic Aortic Surgery.
Guo, Ming Hao; Tran, Diem; Glineur, David; Al-Atassi, Talal; Boodhwani, Munir.
Afiliación
  • Guo MH; Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada.
  • Tran D; Division of Cardiac Anesthesia, University of Ottawa Heart Institute, Ottawa, Canada.
  • Glineur D; Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada.
  • Al-Atassi T; Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada.
  • Boodhwani M; Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada. Electronic address: mboodhwani@ottawaheart.ca.
Ann Thorac Surg ; 111(3): 872-880, 2021 03.
Article en En | MEDLINE | ID: mdl-32771466
ABSTRACT

BACKGROUND:

The impact of acute kidney injury (AKI) in thoracic aortic surgery is not well defined. This study aimed to examine the impact of varying severity of AKI on in-hospital and long-term outcome in these patients.

METHODS:

From 2004 to 2018, 1142 patients underwent thoracic aortic surgery at a single institution (University of Ottawa Heart Institute, Ottawa, Canada) and were stratified into 4 groups on the basis of the severity of postoperative AKI no AKI (n = 705), Acute Kidney Injury Network (AKIN) stage 1 (n = 261), AKIN stage 2 (n = 72), and AKIN stage 3 (n = 104). Outcomes include in-hospital mortality, morbidity, and long-term survival. Multivariable logistic regression was used to identify independent predictors of AKI. Propensity score matching was performed to identify pairs of patients without postoperative AKI or with AKIN stage 1 AKI, as well as pairs of patients without postoperative AKI and those with AKIN stage 2 or higher AKI. Kaplan-Meier curves were plotted for late survival.

RESULTS:

In the propensity-matched cohort, patients with postoperative AKIN stage I AKI had worse in-hospital mortality but comparable long-term survival when compared with patients without postoperative AKI. Patients with AKIN stage 2 or higher AKI experienced significantly higher in-hospital mortality compared with patients without postoperative AKI (15.9% vs 4.6%; P < .01) and worse 8-year survival (65.9% ± 34.1% vs 80.1% ± 20.0%; P < .01).

CONCLUSIONS:

Moderate to severe AKI is a serious complication and is associated with significantly worse short- and long-term outcomes; targeting mild AKI with therapeutic intervention is an important step in improving patient outcomes.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedades de la Aorta / Complicaciones Posoperatorias / Procedimientos Quirúrgicos Vasculares / Puntaje de Propensión / Lesión Renal Aguda Tipo de estudio: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Ann Thorac Surg Año: 2021 Tipo del documento: Article País de afiliación: Canadá

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedades de la Aorta / Complicaciones Posoperatorias / Procedimientos Quirúrgicos Vasculares / Puntaje de Propensión / Lesión Renal Aguda Tipo de estudio: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Ann Thorac Surg Año: 2021 Tipo del documento: Article País de afiliación: Canadá