Intraoperative blood transfusion volume is an independent risk factor for postoperative acute kidney injury in type A ac
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RESEARCH ARTICLE
Open Access
Intraoperative blood transfusion volume is an independent risk factor for postoperative acute kidney injury in type A acute aortic dissection Yanli Liu1†, Yuqiang Shang2†, Ding Long1 and Li Yu1*
Abstract Background: Type A acute aortic dissection is a life-threatening disease associated with adverse clinical outcomes. Acute kidney injury (AKI) is common after surgery. However, the relationship between intraoperative blood transfusion and postoperative AKI remains unclear. Methods: The records of 130 patients who underwent type A acute aortic dissection surgery from January 2015 to December 2018 were retrospectively analyzed. According to the Kidney Disease Improving Global Outcomes criteria, postoperative AKI was defined based on serum creatinine concentration. Multivariable logistic regression analysis was applied to estimate the independent association between intraoperative blood transfusion volume and the risk of postoperative AKI. Results: Postoperative AKI was observed in 82 patients (63.08%). The in-hospital mortality was 16.15% (n = 21). Multivariate logistic regression showed that the amount of intraoperative blood transfusion was independently associated with the risk of postoperative AKI in a dose-dependent manner. Every 200 ml increment of blood transfusion volume was associated with a 31% increase in AKI risk (odds ratio 1.31 and 95% confidence interval 1.01–1.71). Conclusions: Intraoperative transfusion volume may increase the incidence of postoperative AKI. The mechanism and influence of transfusion thresholds on AKI need to be explored in the future. Keywords: Blood transfusion, Acute kidney injury, Type A acute aortic dissection Background Acute aortic dissection remains a clinical emergency characterized by anterior chest or back pain and has high morbidity and mortality, especially for type A acute aortic dissection. Unlike other elective cardiac surgery, in emergency aortic repair for type A acute aortic *Correspondence: [email protected] † Yanli Liu and Yuqiang Shang have contributed equally to this work 1 Intensive Care Unit, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China Full list of author information is available at the end of the article
dissection, patients often suffer from unstable hemodynamics, coagulopathy, and organ malperfusion. Acute kidney injury (AKI) is a common complication and has been reported as an important risk factor for mortality in patients undergoing cardiac surgery [1, 2]. More than 30% of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are likely to develop AKI and approximately 3% of patients need renal replacement therapy (RRT) for severe AKI. Various risk factors for AKI, including volume depletion, hypotension, anemia, and blood transfusion, were identified in reports [3, 4]. Freeland and colleagues reported that blood transfusion
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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