Intraoperative hemodynamics in prediction of postoperative kidney injury after type a aortic dissection surgery: a retrospective cohort study
Background Type A aortic dissection (TAAD) is a severe cardiovascular condition associated with high risks for postoperative complications, particularly renal dysfunction. This study investigated whether intraoperative hypotension and venous congestion are important predictors of postoperative kidne...
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Taylor & Francis Group
2025-12-01
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| Series: | Annals of Medicine |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/07853890.2025.2474859 |
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| author | Lihai Chen Yi Cheng Xinyi Bu Chen Zhang Jie Sun Xuesheng Liu Siyu Kong Yali Ge Hongwei Shi Jifang Zhou |
| author_facet | Lihai Chen Yi Cheng Xinyi Bu Chen Zhang Jie Sun Xuesheng Liu Siyu Kong Yali Ge Hongwei Shi Jifang Zhou |
| author_sort | Lihai Chen |
| collection | DOAJ |
| description | Background Type A aortic dissection (TAAD) is a severe cardiovascular condition associated with high risks for postoperative complications, particularly renal dysfunction. This study investigated whether intraoperative hypotension and venous congestion are important predictors of postoperative kidney injury and major adverse events.Methods We retrospectively analyzed 543 adults undergoing TAAD surgery (2016–2023). Primary outcomes were acute kidney injury (AKI) and acute kidney disease (AKD). Secondary outcomes included death, stroke and composite outcome. Patients were divided into four groups: AKI only, AKD only, AKI and AKD, Non-AKI or AKD. We used restricted cubic spline and multivariate logistic regression models to adjust for confounding factors.Results AKI or AKD was significantly associated with each 10-minute epoch of central venous pressure (CVP) ≥10, 12, 16, 20 mmHg (all p < 0.001), with each 60-minute epoch of CVP ≥10, 12, 16, 20 mmHg area under the curve (AUC) (all p < 0.001). Regarding death, a 6% to 13% increase rate for each 10-minute epoch of CVP ≥10, 12, 16, 20 mmHg (all p ≤ 0.003), a 5% to 21% increase for each 60-minute epoch of CVP ≥10, 12, 16, 20 mmHg AUC (all p < 0.001). In terms of stroke risk, a 5% increase rate for every 10-minute increase in the CVP AUC above 16 mmHg, and an 11% increased risk for CVP AUC above 20 mmHg (p = 0.039 and p = 0.031, respectively).Conclusion Elevated CVP and lower MAP levels were linked to postoperative AKI and AKD risk. CVP showed stronger associations with mortality and stroke. Optimizing perioperative hemodynamic management may improve individualized interventions. |
| format | Article |
| id | doaj-art-65c057acb9e0481e8aeeb5645e30b03f |
| institution | DOAJ |
| issn | 0785-3890 1365-2060 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Annals of Medicine |
| spelling | doaj-art-65c057acb9e0481e8aeeb5645e30b03f2025-08-20T03:21:39ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602025-12-0157110.1080/07853890.2025.2474859Intraoperative hemodynamics in prediction of postoperative kidney injury after type a aortic dissection surgery: a retrospective cohort studyLihai Chen0Yi Cheng1Xinyi Bu2Chen Zhang3Jie Sun4Xuesheng Liu5Siyu Kong6Yali Ge7Hongwei Shi8Jifang Zhou9Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, ChinaSchool of International Business, China Pharmaceutical University, Nanjing, Jiangsu, ChinaDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, ChinaDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, ChinaDepartment of Anesthesiology, Zhongda Hospital, Southeast University, Nanjing, ChinaDepartment of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, ChinaSchool of International Business, China Pharmaceutical University, Nanjing, Jiangsu, ChinaDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, ChinaDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, ChinaSchool of International Business, China Pharmaceutical University, Nanjing, Jiangsu, ChinaBackground Type A aortic dissection (TAAD) is a severe cardiovascular condition associated with high risks for postoperative complications, particularly renal dysfunction. This study investigated whether intraoperative hypotension and venous congestion are important predictors of postoperative kidney injury and major adverse events.Methods We retrospectively analyzed 543 adults undergoing TAAD surgery (2016–2023). Primary outcomes were acute kidney injury (AKI) and acute kidney disease (AKD). Secondary outcomes included death, stroke and composite outcome. Patients were divided into four groups: AKI only, AKD only, AKI and AKD, Non-AKI or AKD. We used restricted cubic spline and multivariate logistic regression models to adjust for confounding factors.Results AKI or AKD was significantly associated with each 10-minute epoch of central venous pressure (CVP) ≥10, 12, 16, 20 mmHg (all p < 0.001), with each 60-minute epoch of CVP ≥10, 12, 16, 20 mmHg area under the curve (AUC) (all p < 0.001). Regarding death, a 6% to 13% increase rate for each 10-minute epoch of CVP ≥10, 12, 16, 20 mmHg (all p ≤ 0.003), a 5% to 21% increase for each 60-minute epoch of CVP ≥10, 12, 16, 20 mmHg AUC (all p < 0.001). In terms of stroke risk, a 5% increase rate for every 10-minute increase in the CVP AUC above 16 mmHg, and an 11% increased risk for CVP AUC above 20 mmHg (p = 0.039 and p = 0.031, respectively).Conclusion Elevated CVP and lower MAP levels were linked to postoperative AKI and AKD risk. CVP showed stronger associations with mortality and stroke. Optimizing perioperative hemodynamic management may improve individualized interventions.https://www.tandfonline.com/doi/10.1080/07853890.2025.2474859Acute kidney injuryintraoperative hypotensionvenous congestionacute kidney diseasetype A aortic dissection |
| spellingShingle | Lihai Chen Yi Cheng Xinyi Bu Chen Zhang Jie Sun Xuesheng Liu Siyu Kong Yali Ge Hongwei Shi Jifang Zhou Intraoperative hemodynamics in prediction of postoperative kidney injury after type a aortic dissection surgery: a retrospective cohort study Annals of Medicine Acute kidney injury intraoperative hypotension venous congestion acute kidney disease type A aortic dissection |
| title | Intraoperative hemodynamics in prediction of postoperative kidney injury after type a aortic dissection surgery: a retrospective cohort study |
| title_full | Intraoperative hemodynamics in prediction of postoperative kidney injury after type a aortic dissection surgery: a retrospective cohort study |
| title_fullStr | Intraoperative hemodynamics in prediction of postoperative kidney injury after type a aortic dissection surgery: a retrospective cohort study |
| title_full_unstemmed | Intraoperative hemodynamics in prediction of postoperative kidney injury after type a aortic dissection surgery: a retrospective cohort study |
| title_short | Intraoperative hemodynamics in prediction of postoperative kidney injury after type a aortic dissection surgery: a retrospective cohort study |
| title_sort | intraoperative hemodynamics in prediction of postoperative kidney injury after type a aortic dissection surgery a retrospective cohort study |
| topic | Acute kidney injury intraoperative hypotension venous congestion acute kidney disease type A aortic dissection |
| url | https://www.tandfonline.com/doi/10.1080/07853890.2025.2474859 |
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