Prognostic factors for in-hospital mortality in patients with acute kidney injury requiring continuous renal replacement therapy undergoing surgery for acute Stanford type A aortic dissection

Abstract

Objective: To evaluate prognostic factors for in-hospital mortality in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) undergoing surgery for acute Stanford type A aortic dissection. Methods: Retrospective analysis were conducted for 60 patients diagnosed with AKI requiring CRRT undergoing surgery for acute Stanford type A aortic dissection at Beijing Anzhen Hospital, Capital Medical University from March 2015 to September 2016. There were 43 male and 17 female patients with an mean age of (50±14) years. Demographic characteristics, diagnosis, perioperative periodrelated data, clinical parameters during CRRT were collected to set up a database. The patients were divided into survival group and non-survival group according to in-hospital mortality. The prognostic factors of mortality in-hospital after AKI requiring CRRT were analyzed by multivariate Logistic regression analysis regression. Results: In the 60 adult patients who had received CRRT, 21 patients (35.0%) died. There were significant differences between died and survival patients on proportion of age>60 years (χ(2)=6.851, P=0.003), lactic acid levels at 12-hour after CRRT (t=-3.631, P=0.004), lactic acid levels at 24 hours after CRRT (t=-2.986, P=0.032), proportion of body mass index >25 kg/m(2) (χ(2)=5.660, P=0.041), cardiopulmonary bypass time (t=-2.720, P=0.001). Multivariate Logistic regression analysis revealed that age≥60 years (OR=16.450, 95% CI: 2.172 to 84.589); high lactic acid levels at 12-hour after CRRT (OR=1.719, 95% CI: 1.998 to 2.960) and long cardiopulmonary bypass time (OR=1.028, 95% CI: 1.004 to 1.052) (all P<0.05) were independent prognostic factors of in-hospital mortality. Conclusions: Age ≥60 years, high lactic acid levels at 12-hour after CRRT and long cardiopulmonary bypass time were independent prognostic factors of patients with AKI requiring CRRT after aortic surgery. Proper identification and management shall improve the prognosis of patients.