AIM To investigate the prognosis and risk factors of mortality in Stanford type A aortic dissection (AAD) patients with severe post-operation hyperbilirubinemia and acute kidney injury (AKI).
METHODS Patients who underwent surgery for AAD at Xijing Hospital between January 2015 and December 2018 were retrospectively screened and patients with severe post-operation hyperbilirubinemia and AKI were included in the present study. In-hospital mortality and long-term mortality were assessed as endpoints and univariate and multivariate analyses were performed to identify the risk factors of in-hospital mortality. Kaplan-Meier survival curve was employed to assess the long-term mortality and the long-term mortality of patients with different AKI stages.
RESULTS Two hundred and twenty one patients were included, of whom 50 received continuous renal replacement therapy (CRRT) and 82 died during their hospital stay. The 1-, 2-, and 3-year accumulated mortality were 39.0%, 40.2% and 41.1%, respectively. Multivariate logistic regression analysis showed that postoperative mean arterial pressure (OR 0.967, 95%CI 0.935-1.000; P = 0.005), postoperative mechanical ventilation time (OR 1.189, 95%CI 1.003-1.410; P = 0.046), total amount of blood transfusion (OR 1.019, 95%CI 1.003-1.036; P = 0.018) and AKI stage 3 (OR 12.639, 95%CI 5.409-34.388; P = 0.01) were independent risk factors of in-hospital mortality.
CONCLUSION Patients with severe hyperbilirubinemia and AKI after AAD surgery have high in-hospital and long-term mortality. Stage 3 AKI, lower postoperative mean arterial pressure, prolonged postoperative mechanical ventilation time, and increased postoperative blood transfusion volume are associated with increased in-hospital mortality. Patients with these risk factors warrant more intensive monitoring.
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