AUTHOR=Zhao Weiwei , Wang Ya-peng , Tang Xinlong , Jiang Yi , Xue Yunxing , Wang Yali , Ding Qiuju , Chen Huimei , Wang Dongjin , Cheng YongQing , Ge Min , Zhou Qing 

TITLE=Development and validation of LCMM prediction algorithms to estimate recovery pattern of postoperative AKI in type A aortic dissection: a retrospective study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1364332

DOI=10.3389/fcvm.2024.1364332

ISSN=2297-055X

ABSTRACT=Background: Postoperative acute kidney injury (PO-AKI) is a prevalent complication among patients with acute type A aortic dissection (aTAAD) for which unrecognized trajectories of renal function recovery, and their heterogeneity, may underpin poor success in identifying effective therapies.Methods: This was a retrospective, single-center cohort study in a regional Great Vessel Center including patients undergoing aortic dissection surgery. Estimated GFR (eGFR) recovery trajectories of PO-AKI were defined though the unsupervised latent class mixture modeling (LCMM), with assessment of patient and procedural characteristics, complications and early-term survival. Internal validation were performed by resampling.Results: A total of 1295 aTAAD patients underwent surgery and 645 (49.8%) developed PO-AKI. Among PO-AKI cohort, the LCMM identified two distinct eGFR trajectories: early recovery (ER-AKI, 51.8% of patients), and late or no recovery (LNR-AKI, 48.2% of patients). Binary logistic regression identified 5 critical determinants regarding poor renal recovery, including chronic kidney disease (CKD) history, renal hypoperfusion, circulation arrest time, intraoperative urine and myoglobin. LNR-AKI was associated with increased mortality, continuous renal replacement therapies, mechanical ventilation, ICU stay and hospital stay. Assessment of the predictive model was good, with AUC of 0.73 (95% CI: 0.69-0.76), sensitivity of 61.74%, specificity of 75.15%. The internal validation derived a consistent average AUC of 0.73. The nomogram was constructed for clinicians' convenience.Our study explored the PO-AKI recovery patterns among surgical aTAAD patients, and identified critical determinants that help to predict individuals at risk of poor recovery of renal function.