Key result
Low preoperative serum fibrinogen level was independently associated with an increased risk of postoperative acute kidney injury (OR 1.492) in patients with acute type A aortic dissection.
Why the study?
The relationship between the hemostatic system and prognosis in acute type A aortic dissection had not been evaluated, and the association between preoperative fibrinogen and postoperative AKI was unknown.
Does low preoperative serum fibrinogen level predict postoperative acute kidney injury in patients with acute type A aortic dissection?
Cohort (n=172)
No
Does low preoperative serum fibrinogen level predict postoperative acute kidney injury in patients with acute type A aortic dissection?
Low preoperative serum fibrinogen level and obesity are independent predictors of postoperative acute kidney injury in patients undergoing surgery for acute type A aortic dissection.
May aid preoperative AKI risk stratification in type A dissection; leaves open causal role and intervention effects.
Objective: Acute kidney injury (AKI) after cardiac surgery is associated with serious complication and high risk of mortality. The relationship between hemostatic system and the prognosis of patients with acute type A aortic dissection (ATAAD) has not been evaluated. The purpose of this study was to investigate the association between preoperative serum fibrinogen level and risk of postoperative AKI in patients with ATAAD. Methods: A total of 172 consecutive patients undergoing urgent aortic arch surgery for ATAAD between April 2020 and December 2021 were identified from Beijing Anzhen Hospital aortic surgery database. The primary outcome was postoperative AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The univariate and multivariate logistic regression analysis was done to assess the independent predictors of risk for postoperative AKI. Receiver operating characteristic (ROC) curve was generated to evaluate the predictive probabilities of risk factors for AKI.Results: In our study, 51.2% (88/172) patients developed postoperative AKI. Multivariate logistic regression analysis identified low preoperative serum fibrinogen level (OR, 1.492; 95% CI, 1.023 to 2.476; p = 0.021) and increased body mass index (BMI) (OR, 1.153; 95% CI, 1.003 to 1.327; p = 0.046) as independent predictors of postoperative AKI in patients with ATAAD. A mixed effect analysis of variance modeling revealed that obese patients with low preoperative serum fibrinogen level had higher incidence of postoperative AKI (p = 0.04). The ROC curve indicated that low preoperative serum fibrinogen level was a significant predictor of AKI [area under the curve (AUC), 0.771; p < 0.001].Conclusions: Low preoperative serum fibrinogen level and obesity were associated with the risk of postoperative AKI in patients with ATAAD. These data suggested that low preoperative serum fibrinogen level was preferred marker for predicting the postoperative AKI, especially in obese patients with ATAAD.
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Guan et al. (2022) conducted a cohort in Acute type A aortic dissection (ATAAD) (n=172). Low preoperative serum fibrinogen level vs. Normal or higher preoperative serum fibrinogen level was evaluated on Postoperative acute kidney injury (AKI) (OR 1.492, 95% CI 1.023 to 2.476, p=0.021). Low preoperative serum fibrinogen level was independently associated with an increased risk of postoperative acute kidney injury (OR 1.492) in patients with acute type A aortic dissection.
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