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首页> 外文期刊>Therapeutic advances in cardiovascular disease. >Impact of preoperative elevated serum creatinine on long-term outcome of patients undergoing aortic repair with Stanford A dissection: a retrospective matched pair analysis
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Impact of preoperative elevated serum creatinine on long-term outcome of patients undergoing aortic repair with Stanford A dissection: a retrospective matched pair analysis

机译：术前血清肌酐升高对斯坦福A夹层主动脉修复患者远期结局的影响：回顾性配对分析

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The aim of the present study was to determine whether raised preoperative serum creatinine affected the long-term outcome in patients undergoing surgical aortic repair for Stanford A acute aortic dissection (AAD). A total of 240 patients diagnosed with Stanford A AAD underwent surgical repair from January 2006 to April 2015. A propensity score matching was applied, resulting in 73 pairs consisting of one group with normal and one group with preoperative elevated creatinine levels. The cohorts were well balanced for baseline and preoperative clinical characteristics. Both groups were compared regarding their early postoperative variables, as well as estimated survival with up to 9-year follow up. Also, the impact of acute postoperative kidney injury and its severity on long-term survival was analyzed. The proportion of patients suffering Stanford A AAD with raised creatinine levels was 31.3% (n = 75). After propensity matching, there were no statistically significant differences regarding demographics, comorbidities, preoperative baseline and clinical characteristics. Postoperatively matched patients with elevated creatinine had longer intensive care unit (p p = 0.002), prolonged intubation times (p = 0.014), higher need for hemofiltration (p p = 0.16), infection (p = 0.005), and trend toward higher incidence of sepsis (p = 0.097). However, there were no significant differences regarding 30-day mortality (20.5% versus 20.5%, p = 1.000) and long-term overall survival. Further, neither the incidence nor the different stages of acute kidney injury according to the Acute Kidney Injury Network showed any statistically significant differences in terms of long-term survival for both groups [log rank p = 0.636, Breslow (generalized Wilcoxon) p = 0.470, Tarone–Ware p = 0.558]. Patients with elevated creatinine levels undergoing surgical repair for Stanford A AAD demonstrate higher rate of early postoperative complications. However, 30-day mortality and long-term survival in this patient cohort is not significantly impaired.
机译：本研究的目的是确定术前血清肌酐升高是否会影响接受斯坦福A型急性主动脉夹层（AAD）外科手术主动脉修复的患者的长期结局。从2006年1月至2015年4月，共有240例被诊断为斯坦福A AAD的患者接受了外科手术修复。应用了倾向评分匹配，结果产生73对，其中一组正常且一组患者术前肌酐水平升高。队列的基线和术前临床特征均很均衡。比较两组患者的术后早期变量以及估计的长达9年的随访生存率。此外，分析了急性术后肾脏损伤及其严重程度对长期生存的影响。患肌酐水平升高的斯坦福A AAD患者的比例为31.3％（n = 75）。倾向匹配后，人口统计学，合并症，术前基线和临床特征在统计学上没有显着差异。肌酐水平升高的术后匹配患者重症监护病房时间更长（pp = 0.002），插管时间延长（p = 0.014），需要更高的血液滤过率（pp = 0.16），感染（p = 0.005）以及败血症发生率更高的趋势（p ＝ 0.097）。但是，关于30天死亡率（20.5％对20.5％，p = 1.000）和长期总体生存率没有显着差异。此外，根据急性肾脏损伤网络，急性肾损伤的发生率和不同阶段均未显示两组的长期存活率有统计学意义上的显着差异[对数秩p = 0.636，Breslow（广义Wilcoxon）p = 0.470 ，Tarone-Ware p = 0.558]。肌酐水平升高的患者因斯坦福大学AAD手术接受修复，术后早期并发症发生率更高。但是，该患者队列的30天死亡率和长期生存率并未受到明显损害。

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