Journal of cardiothoracic surgery · 2026
Factors associated with postoperative acute kidney injury in stanford type a aortic dissection in china: a systematic review and meta-analysis.
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Ning Liping, Chen Mengling, Luo Huanhuan, Xie Peng, Li Zuowei, Liao Qiaoling
Аннотация
OBJECTIVE: This study aimed to explore the factors associated with postoperative acute kidney injury in Chinese Stanford type A aortic dissection patients through a systematic review and meta-analysis.
METHODS: CNKI, WanFang Database, VIP, SinoMed, PubMed, Web of Science, Embase and Cochrane Library were comprehensively searched from inception until September 2025. Two reviewers independently conducted study selection, data extraction, and quality assessment. Meta-analysis was performed using Stata 15.1 and R 4.5.0 software. The certainty of evidence was evaluated using the GRADE tool.
RESULTS: A total of 47 eligible studies comprising 9077 patients were included. Based on these observational studies, which predominantly had low to very low certainty of evidence (GRADE), the following factors were found to be associated with postoperative AKI in Chinese Stanford type A aortic dissection patients: age[adjusted odds ratio (OR) = 1.10, 95% confidence interval (CI): 1.03-1.19, p < 0.05], BMI[OR = 1.20, 95%CI: 1.17-1.24, p < 0.001], hypertension history[OR = 2.74, 95%CI: 2.34-3.21, p < 0.001], renal artery involvement[OR = 4.40, 95%CI: 2.81-6.91, p < 0.001], preoperative cardiac tamponade[OR = 3.47, 95%CI: 1.93-6.26, p < 0.001], preoperative serum creatinine[OR = 1.16, 95%CI: 1.09-1.23, p < 0.001], preoperative platelet[OR = 0.96, 95%CI: 0.92-1.00, p < 0.05], preoperative serum myoglobin[OR = 1.69, 95%CI: 1.44-1.98, p < 0.001], preoperative serum cystatin C[OR = 6.59, 95%CI: 3.77-11.50, p < 0.001], cardiopulmonary bypass time[adjusted OR = 1.01, 95%CI: 1.00-1.02, p < 0.05], CPB > 180 min[OR = 3.48, 95%CI: 1.65-7.30, p < 0.01], operative time[OR = 1.69, 95%CI: 1.33-2.14, p < 0.05], deep hypothermic circulatory arrest time[OR = 1.16, 95%CI: 1.10-1.22, p < 0.001], aortic cross-clamp time[OR = 1.11, 95%CI: 1.01-1.21, p < 0.05], intraoperative RBCs transfusion volume[adjusted OR = 1.17, 95%CI: 1.02-1.35, p < 0.05], intraoperative urine output[OR = 0.75, 95%CI: 0.64-0.88, p < 0.001], mechanical ventilation time[OR = 1.01, 95%CI: 1.01-1.02, p < 0.001] and postoperative procalcitonin[OR = 1.03, 95%CI: 1.01-1.06, p < 0.05].
CONCLUSION: This study demonstrates that factors associated with postoperative acute kidney injury in Chinese Stanford type A aortic dissection patients are closely related to the perioperative period. These findings may help clinicians identify risk factors early and facilitate the development of preventive strategies to improve patient outcomes.
REGISTRATION: The research is registered on the PROSPERO website with the registration number CRD420250651792.
METHODS: CNKI, WanFang Database, VIP, SinoMed, PubMed, Web of Science, Embase and Cochrane Library were comprehensively searched from inception until September 2025. Two reviewers independently conducted study selection, data extraction, and quality assessment. Meta-analysis was performed using Stata 15.1 and R 4.5.0 software. The certainty of evidence was evaluated using the GRADE tool.
RESULTS: A total of 47 eligible studies comprising 9077 patients were included. Based on these observational studies, which predominantly had low to very low certainty of evidence (GRADE), the following factors were found to be associated with postoperative AKI in Chinese Stanford type A aortic dissection patients: age[adjusted odds ratio (OR) = 1.10, 95% confidence interval (CI): 1.03-1.19, p < 0.05], BMI[OR = 1.20, 95%CI: 1.17-1.24, p < 0.001], hypertension history[OR = 2.74, 95%CI: 2.34-3.21, p < 0.001], renal artery involvement[OR = 4.40, 95%CI: 2.81-6.91, p < 0.001], preoperative cardiac tamponade[OR = 3.47, 95%CI: 1.93-6.26, p < 0.001], preoperative serum creatinine[OR = 1.16, 95%CI: 1.09-1.23, p < 0.001], preoperative platelet[OR = 0.96, 95%CI: 0.92-1.00, p < 0.05], preoperative serum myoglobin[OR = 1.69, 95%CI: 1.44-1.98, p < 0.001], preoperative serum cystatin C[OR = 6.59, 95%CI: 3.77-11.50, p < 0.001], cardiopulmonary bypass time[adjusted OR = 1.01, 95%CI: 1.00-1.02, p < 0.05], CPB > 180 min[OR = 3.48, 95%CI: 1.65-7.30, p < 0.01], operative time[OR = 1.69, 95%CI: 1.33-2.14, p < 0.05], deep hypothermic circulatory arrest time[OR = 1.16, 95%CI: 1.10-1.22, p < 0.001], aortic cross-clamp time[OR = 1.11, 95%CI: 1.01-1.21, p < 0.05], intraoperative RBCs transfusion volume[adjusted OR = 1.17, 95%CI: 1.02-1.35, p < 0.05], intraoperative urine output[OR = 0.75, 95%CI: 0.64-0.88, p < 0.001], mechanical ventilation time[OR = 1.01, 95%CI: 1.01-1.02, p < 0.001] and postoperative procalcitonin[OR = 1.03, 95%CI: 1.01-1.06, p < 0.05].
CONCLUSION: This study demonstrates that factors associated with postoperative acute kidney injury in Chinese Stanford type A aortic dissection patients are closely related to the perioperative period. These findings may help clinicians identify risk factors early and facilitate the development of preventive strategies to improve patient outcomes.
REGISTRATION: The research is registered on the PROSPERO website with the registration number CRD420250651792.