Postdoctoral Fellow University of Pittsburgh Pittsburgh, Pennsylvania, United States
Background: Acute kidney injury (AKI) is a common complication in critically ill patients and frequently occurs in patients with acute aortic syndromes. However, it has not been extensively studied in the context of acute type B aortic dissection (TBAD). AKI in TBAD can arise from several mechanisms, including hypotension, renal malperfusion and preexisting kidney dysfunction. In some cases, thoracic endovascular aortic repair (TEVAR) is performed to treat complicated TBAD and select uncomplicated TBAD with high-risk features. We sought to evaluate the incidence and long-term impact of AKI in patients with TBAD.
METHODS AND RESULTS: We performed a study-level meta-analysis of reconstructed time-to-event data from Kaplan-Meier curves of studies published between 2000-2024. Eligibility criteria included populations with TBAD who received either medical therapy or TEVAR, and the outcome was overall survival during longitudinal follow-up. This meta-analysis was designed according to the PECOS framework and conducted in compliance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The study protocol was prospectively registered in the PROSPERO database (CRD420250654959). In total, 4 studies met our eligibility criteria and included a total of 1,051 patients with TBAD included in the Kaplan-Meier curves. Among these, 390 patients (37.1%) presented with AKI at the time of hospitalization. Overall, the presence of AKI was associated with a significantly increased risk of mortality compared to patients without AKI (HR: 1.59; 95% CI: 1.23-2.06; P < 0.001), with the highest risk observed during the perioperative period. In a subgroup analysis of three studies involving 478 patients who underwent TEVAR for TBAD, 99 patients (20.7%) had AKI. In this subgroup, AKI remained significantly associated with an increased mortality risk (HR: 2.27; 95% CI: 1.23-4.18; P = 0.009). Leave-one-out analysis confirmed the robustness of the results, which remained significant across all iterations. Funnel plots showed no evidence of publication bias in either the overall cohort or the subgroup analysis.
Conclusion: AKI is prevalent in TBAD patients and associated with increased mortality, emphasizing the need for further investigation into its underlying mechanisms and the formulation of targeted management strategies to enhance patient outcomes.
