Association between preoperative serum myoglobin and acute kidney injury after Stanford Type A aortic dissection surgery

Suwei Chen; Chenhan Zhang; Yongliang Zhong; Bing Tang; Qiang Xie; Rutao Guo; Zhiyu Qiao; Chengnan Li; Yipeng Ge; Junming Zhu

doi:10.1016/j.cca.2023.117232

Association between preoperative serum myoglobin and acute kidney injury after Stanford Type A aortic dissection surgery

Clin Chim Acta. 2023 Feb 15:541:117232. doi: 10.1016/j.cca.2023.117232. Epub 2023 Jan 20.

Authors

Affiliations

¹ Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
² Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. Electronic address: Yipengge@126.com.
³ Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. Electronic address: anzhenzjm@ccmu.edu.cn.

PMID: 36690242
DOI: 10.1016/j.cca.2023.117232

Abstract

Background: Acute kidney injury (AKI) is a common complication after Type A aortic dissection (TAAD) surgery, and it is associated with poor outcomes. The nephrotoxic effect of myoglobin was established, but its correlation with AKI following TAAD repair still lacks sufficient evidence. We clarified the correlation between preoperative serum myoglobin (pre-sMyo) concentrations and AKI after TAAD surgery.

Method: A retrospective analysis was performed on the perioperative data of 382 patients treated with TAAD surgery at Beijing Anzhen Hospital. AKI was defined and classified according to the criteria established by the Kidney Disease: Improving Global Outcomes Acute Kidney Injury Work Group. We attempted to determine the correlation between pre-sMyo concentrations and postoperative AKI.

Results: The incidences of Stage 1, 2, and 3 AKI were 37.3 % (57/153), 23.5 % (36/153), and 39.2 % (60/153), respectively. The pre-sMyo concentrations of the AKI group were significantly increased than the non-AKI group [43.1 (21.4, 107.5) vs 26.4 (18.0, 37.2), P < 0.001]. Pre-sMyo concentrations have a linear correlation with preoperative renal function-related indicators. The multivariable logistic regression analysis showed that Ln (pre-sMyo) was an independent risk factor for AKI. When the pre-sMyo concentration was at the fourth quartile [109.3 (64.8, 213.4) ng/ml], the risk of developing any-stage and severe AKI was significantly increased (OR = 4.333, 95 % CI: 2.364-7.943, P < 0.001; OR = 3.862, 95 %, CI: 2.011-7.419, P < 0.001). This difference persisted after adjustment (OR = 3.830, 95 % CI: 1.848-7.936, P < 0.001; OR = 2.330, 95 % CI: 1.045-5.199, P = 0.039). Furthermore, pre-sMyo concentrations were not affected by lower limb malperfusion, myocardial malperfusion, and cardiac tamponade.

Conclusions: Increased pre-sMyo concentrations correlated with postoperative AKI in TAAD, which may increase the risk of developing any-stage AKI and severe AKI after TAAD surgery.

Keywords: Acute Kidney Injury; Aortic Repair; Malperfusion; Serum Myoglobin; Stanford Type A Aortic Dissection.

MeSH terms

Acute Kidney Injury* / etiology
Aortic Dissection*
Humans
Myoglobin
Postoperative Complications
Retrospective Studies
Risk Factors

Substances

Myoglobin
1,3,4,6-tetra-O-acetyl-2-azido-2-deoxyglucopyranose