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Background: This is the first meta-analysis investigating the incidence and risk factors of postoperative acute kidney injury (AKI) in patients with type A aortic dissection (TAAD) and the impact of the AKI on short-term outcomes.
This systematic review and meta-analysis were conducted and reported in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Multiple electronic literature databases were searched using predefined criteria. Articles that were published between January 1, 2011 and November 30, 2016 were screened; 7 eligible articles were included in the meta-analysis. Differences are expressed as odds risk (OR) with 95% confidential interval (CI). Study heterogeneity was tested using the I2 statistic. Study heterogeneity was considered significant when P values < 0.10 or I2 > 50%. A fixed-effects model was used when study heterogeneity was not significant; a random effects model was used when study heterogeneity was significant. Egger’s linear regression test was used to estimate publication bias. Meta-regression analysis was performed to examine whether covariates, which could be potential modifiers, can affect the end results of the meta-analysis.
The odds risk of actual total incidence of AKI events from the 7 studies was 0.46 (95% CI: 0.43-0.48). The meta-analysis revealed that postoperative AKI was associated with a 247% increase in 30-day postoperative mortality (OR: 3.47, 95% CI: 2.18-5.51, P<0.0001) without significant study heterogeneity and publication bias. Subgroup analysis found that the patients with stage 2 or 3 AKI showed a 445% increase in the mortality compared with the patients without the complication (OR: 5.45, 95% CI: 2.87-10.36, P<0.0001). Meta-regression showed that the potential modifiers, such as publication year, AKI definition, male sex, mean age, preoperative creatinine levels, and body mass index (BMI) had no significant effects on the association between AKI and 30-day mortality. Postoperative AKI also increased the incidence of 30-day postoperative stroke and bleeding by 143% (OR: 2.43, 95% CI: 1.52-3.87, P<0.0001) and 432% (OR: 5.32, 95% CI: 2.11-13.42, P<0.0001), respectively. Multiple logistic regression analysis revealed that patients’ advancing age (OR: 1.26, 95% CI: 1.11-1.43, P<0.0001), high BMI (OR: 1.26, 95% CI: 1.02-1.55, P=0.175), and perioperative sepsis (OR: 1.91, 95% CI: 1.13-3.29, P=0.017) independently correlated with postoperative AKI in patients with TAAD.
Patients with TAAD appear to a have high risk of postoperative AKI, which may increase 30-day postoperative mortality and the incidences of stroke and bleeding. Patients’ advancing age, high BMI, and perioperative sepsis independently correlate with postoperative AKI.