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Serum Myoglobin Is Associated With Postoperative Acute Kidney Injury in Stanford Type A Aortic Dissection
Chen Yang1, Peng Hou1, Dongxu Wang1
1Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Background:
The correlation between rhabdomyolysis and postoperative acute kidney injury has been reported in several surgical procedures. As a good predictor of rhabdomyolysis-related acute kidney injury, an elevated serum myoglobin level was often observed after total aortic arch replacement combined with frozen elephant trunk implantation. However, the correlation between serum myoglobin and acute kidney injury in such patients had not been established.
Methods:
Totally 398 stanford type A aortic dissection patients who underwent total aortic arch replacement combined with frozen elephant trunk implantation were enrolled in this retrospective study. The correlations between serum myoglobin and acute kidney injury as well as the 30-day mortality were assessed.
Results:
Overall, 268(67.3%) patients had acute kidney injury (KDIGO stage 1 or higher) and 75(18.8%) had severe acute kidney injury (KDIGO stage 2&3). Patients who developed acute kidney injury had higher level of perioperative serum myoglobin than patients without acute kidney injury. After adjusting for known acute kidney injury risk factors, logarithmically transformed preoperative serum myoglobin [OR = 1.58 (95% CI, 1.26-1.95), P < 0.001] and postoperative day 1 serum myoglobin [OR = 3.47 (95%CI, 2.27-5.29), P < 0.001] were associated with severe acute kidney injury. These correlation persisted after adjustment for decline in filtration via change in serum creatinine (ΔCr) and biomarkers of cardiac and kidney injury, including N-terminal prohormone of brain natriuretic peptide, cardiac troponin I, creatine kinase-MB, serum creatinine and Cystatin C. Compared with the clinical model, sMb considerably improved the risk discrimination and reclassification for AKI.
Conclusion:
For stanford type A aortic dissection patients underwent total aortic arch replacement with frozen elephant trunk implantation, serum myoglobin can improve postoperative acute kidney injury risk classification. Rhabdomyolysis may be an important supplement to the existing knowledge on the mechanism of acute kidney injury.
Insights
Elevated serum myoglobin levels predict severe acute kidney injury in patients undergoing aortic arch replacement with frozen elephant trunk implantation. This finding aids in better risk classification for postoperative kidney complications.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Biomarkers
Background:
- Rhabdomyolysis is linked to postoperative acute kidney injury (AKI) after various surgeries.
- Elevated serum myoglobin (sMb) is a known predictor of rhabdomyolysis-related AKI.
- The specific correlation between sMb and AKI after total aortic arch replacement with frozen elephant trunk (FET) implantation was not previously established.
Purpose of the Study:
- To investigate the association between serum myoglobin levels and the incidence of postoperative acute kidney injury (AKI).
- To evaluate serum myoglobin as a predictor for severe AKI in patients undergoing total aortic arch replacement combined with FET implantation.
- To assess the role of serum myoglobin in improving risk classification for AKI in this patient cohort.
Main Methods:
- Retrospective study including 398 patients with Stanford type A aortic dissection who underwent total aortic arch replacement with FET implantation.
- Assessed correlations between pre- and postoperative serum myoglobin levels and the occurrence of AKI (KDIGO stage ≥1) and severe AKI (KDIGO stage ≥2).
- Statistical analysis included logistic regression, adjusting for known AKI risk factors and other biomarkers (NT-proBNP, cTnI, CK-MB, creatinine, Cystatin C).
Main Results:
- A high incidence of AKI (67.3%) and severe AKI (18.8%) was observed.
- Patients with AKI exhibited higher perioperative serum myoglobin levels.
- Both preoperative and postoperative day 1 serum myoglobin levels were significantly associated with severe AKI, even after multivariable adjustment. Serum myoglobin improved AKI risk discrimination and reclassification.
Conclusions:
- Serum myoglobin is a valuable biomarker for improving the risk classification of postoperative acute kidney injury in patients undergoing total aortic arch replacement with FET implantation.
- Rhabdomyolysis, indicated by elevated serum myoglobin, may play a significant role in the mechanism of AKI in these complex surgical cases.
- These findings contribute to a better understanding of AKI pathogenesis and risk prediction in cardiovascular surgery patients.
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