{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:50:30Z","timestamp":1788969030871,"version":"build-2803163510"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>In this retrospective study, we investigated the incidence of postoperative acute kidney injury (AKI) and determined the predictors associated with AKI in patients underwent surgeries for acute type A aortic dissection (ATAAD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We enrolled patients diagnosed with ATAAD and received operation. AKI was defined based on the Kidney Disease: Improving Global Outcomes criteria. Potential perioperative predictors were evaluated for postoperative AKI. Univariate and multivariate regression analyses were conducted to identify predictors associated with AKI following surgery. The primary end point was the incidence of postoperative AKI, while the secondary end points included in-hospital mortality and other major surgical complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study enrolled 224 patients in all. There were 155 (69.2%) patients with postoperative AKI, including 55 (24.6%) with KDIGO stage 1, 45 (20.1%) with stage 2 and 55 (24.6%) with stage 3. Twenty-eight patients (12.5%) needed renal replacement therapy after surgery. The total in-hospital mortality was 2.7% (AKI vs. non-AKI: 3.2% vs. 1.4%, <jats:italic>p<\/jats:italic>\u2009=\u20090.669). Multivariate regression analysis found total protein concentrations [odds ratio (OR) 1.136, 95% confidence interval (CI): 1.032\u20131.250, <jats:italic>p<\/jats:italic>\u2009=\u20090.009], intraoperative blood loss (OR 1.002, 95% CI: 1.000\u20131.004, <jats:italic>p<\/jats:italic>\u2009=\u20090.042) and ventilation time (OR 1.011, 95% CI: 1.001\u20131.021, <jats:italic>p<\/jats:italic>\u2009=\u20090.026) were independently associated with AKI. The area under the receiver operating characteristic curve was 0.688 (95% CI: 0.617\u20130.759). Our predictive model demonstrated a sensitivity of 72.5% and a specificity of 57.4%. The ordinal logistic regression analysis found that age (OR 1.055, 95% CI: 1.027\u20131.084, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), body mass index (OR 1.194, 95% CI: 1.104\u20131.291, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), a high total protein to albumin ratio (OR 2.615, 95% CI: 1.234\u20135.540, <jats:italic>p<\/jats:italic>\u2009=\u20090.012) and ventilation time (OR 1.005, 95% CI: 1.001\u20131.008, <jats:italic>p<\/jats:italic>\u2009=\u20090.005) were independently associated with the severity of AKI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A higher preoperative total protein to albumin ratio independently predicted more severe postoperative AKI in patients undergoing surgical treatment for ATAAD. Monitoring preoperative total protein concentrations and the total protein to albumin ratio may assist in identifying patients at higher risk of progressing to severe AKI, though further multicenter validation is required.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1562388","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T06:13:07Z","timestamp":1747030387000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["A higher preoperative total protein to albumin ratio independently predicted more severe postoperative acute kidney injury in patients with acute type A aortic dissection: a retrospective cohort study of 224 cases"],"prefix":"10.3389","volume":"12","author":[{"given":"Xiuhua","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guowei","family":"Tu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiarui","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1038\/nrneph.2017.119","article-title":"Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment","volume":"13","author":"Wang","year":"2017","journal-title":"Nat Rev Nephrol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1186\/s13019-021-01533-8","article-title":"Body mass index is an independent predictor of acute kidney injury after urgent aortic arch surgery for acute DeBakey type I aortic dissection","volume":"16","author":"Liu","year":"2021","journal-title":"J Cardiothorac Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1093\/icvts\/ivaa164","article-title":"Acute kidney injury in patients operated on for type A acute aortic dissection: incidence, risk factors and short-term outcomes","volume":"31","author":"Wang","year":"2020","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"557044","DOI":"10.3389\/fmed.2020.557044","article-title":"The incidence, risk factors and in-hospital mortality of acute kidney injury in patients after surgery for acute type A aortic dissection: a single-center retrospective analysis of 335 patients","volume":"7","author":"Li","year":"2020","journal-title":"Front Med (Lausanne)"},{"key":"B5","doi-asserted-by":"publisher","first-page":"c179","DOI":"10.1159\/000339789","article-title":"KDIGO clinical practice guidelines for acute kidney injury","volume":"120","author":"Khwaja","year":"2012","journal-title":"Nephron Clin Pract"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1971","DOI":"10.1016\/j.athoracsur.2021.06.065","article-title":"Ninety-day readmission after open surgical repair of Stanford type A aortic dissection","volume":"113","author":"Amin","year":"2022","journal-title":"Ann Thorac Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2378","DOI":"10.1111\/jocs.16614","article-title":"The long-term impact of acute renal failure after aortic arch replacement for acute type A aortic dissection","volume":"37","author":"Brown","year":"2022","journal-title":"J Card Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1038\/s41581-023-00683-3","article-title":"Sepsis-associated acute kidney injury: consensus report of the 28th acute disease quality initiative workgroup","volume":"19","author":"Zarbock","year":"2023","journal-title":"Nat Rev Nephrol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"111358","DOI":"10.1016\/j.intimp.2023.111358","article-title":"Serum total protein-to-albumin ratio predicts risk of death in septic acute kidney injury patients: a cohort study","volume":"127","author":"Yin","year":"2024","journal-title":"Int Immunopharmacol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1186\/s13019-021-01536-5","article-title":"European registry of type A aortic dissection (ERTAAD) - 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