Prognostic impact on Type B acute aortic dissection with renal insufficiency: A single-center study

• Main Authors: Xue Bai, Bao-Zhu Wang, Karmacharya Ujit, Zi-Xiang Yu, Qian Zhao, Xiang Ma, Yi-Tong Ma
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2018-01-01
• Series: Cardiology Plus
• Subjects: Estimated glomerular filtration rate; renal insufficiency; type B aortic dissection
• Online Access: http://www.cardiologyplus.org/article.asp?issn=2470-7511;year=2018;volume=3;issue=1;spage=15;epage=20;aulast=Bai
• ISSN: 2470-7511; 2470-752X

Aims: The aim was to study the impact of renal insufficiency on type B acute aortic dissection (AAD), in terms of in-hospital mortality and long-term survival. Materials and Methods: A total of 241 consecutive patients with type B AAD from 2007 to 2014 were enrolled. Based on estimated glomerular filtration rate, two groups were formed: Group A, with e-GFR <60 ml/min/1.73 m2 and Group B, with e-GFR ≥60 ml/min/1.73 m2 and were compared. Logistic regression and Cox regression analyses were used to identify predictors of in-hospital mortality, mortality during follow-ups, and long-term survival. Results: There was no significant difference in general characteristics and hemodynamic status between the two groups (P > 0.05). Both groups received main cardiovascular drugs and/or interventional therapies (P > 0.05). Group A had longer coronary care unit stays than Group B (P < 0.05). Multivariate logistic regression model showed white blood cell (WBC) count (odds ratio [OR], 1.107; 95% confidence interval [CI], 1.016–1.206; P < 0.05), e-GFR < 60 ml/min/1.73 m2 (OR, 4.809; 95% CI, 1.716–13.480; P < 0.05), and in-hospital hypotension (OR, 13.87; 95% CI, 2.544–75.591; P < 0.05) as significant predictors for in-hospital mortality. This was also significant in Cox regression analysis: WBC count (Hazard ratio (HR), 1.108; 95% CI, 1.029–1.194, P < 0.05), e-GFR <60 ml/min/1.73 m2 (HR, 2.572; 95% CI, 1.014–6.524; P < 0.05), and in-hospital hypotension (HR, 3.309; 95% CI, 1.133–9.666; P < 0.05). Kaplan–Meier analysis showed Group A having much lower cumulative survival than Group B. Conclusion: This study shows that moderate-to-severe renal insufficiency is an independent predictor of mortality in type B AAD both during hospital stay and on subsequent follow-ups.