Prognostic value of preoperative ascending aortic diameter on postoperative acute kidney injury in adult cardiac surgery

Abstract Background The ascending aortic diameter (AAD) is common in ultrasound examinations of cardiac surgery patients, and it is important for the prognosis of cardiac patients. The ascending aortic diameter has effect on renal perfusion. However, the impact of AAD on the incidence of postoperative acute kidney injury (AKI) in cardiac surgery patients is still unknown. This study aims to explore the prognostic value of ascending aortic diameter on the incidence of postoperative AKI in cardiac adult patients. Method This retrospective study included patients aged ≥18 years who underwent cardiac operations between April 2023 to July 2023 in Fuwai Hospital, China. Patients were divided into two groups: AKI group and non-AKI group. The values of cardiac ultrasound the day before surgery were collected. The end point was the rate of acute kidney injury. Univariable and multivariable logistic regression analyses were performed to identify the independent risk factors for postoperative AKI. The receiver operating characteristic curve was used to assess model performance. Using another model without AAD, the effect of the addition of AAD was assessed. Result 442 patients were included in this study. Univariable and multivariable results suggested that AAD was an independent factor of postoperative AKI for both on-pump and off-pump cardiac patients (P<0.05). To avoid CPB time confounding factor, we went subgroup analysis of the area under the curve of CPB time further. The addition of AAD improved the area under the curve from 0.67 to 0.72 (P<0.05) in on-pump patients. Conclusion AAD represents a prognostic value of postoperative AKI in adult cardiac surgery. The prognostic value of AAD was higher in on-pump patients.