Risk factors and prognostic analysis of acute kidney injury after Sun's procedure for acute Stanford type A aortic dissection.

Background: Acute kidney injury (AKI) is a frequent and severe complication following Sun's procedure for acute Stanford type A aortic dissection (ATAAD), contributing to prolonged hospitalization and increased mortality. Early identification of patients at high risk for postoperative AKI and adverse outcomes may facilitate timely intervention and improve perioperative management. This study aimed to investigate factors associated with postoperative AKI and identify predictors of short-term outcomes in ATAAD patients undergoing Sun's procedure. Methods: This retrospective study included 128 consecutive ATAAD patients who underwent Sun's procedure at the Affiliated Hospital of Zunyi Medical University between January 2022 and October 2024. Patients were classified into AKI (n=91) and non-AKI (n=37) groups according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Perioperative variables were compared, and variables showing significant associations were further analyzed using multivariate logistic regression. Patients with AKI were followed up for 30 days after discharge via telephone interviews. Eight patients were lost to follow-up, and 83 patients were included in the prognostic analysis. Clinical characteristics between survivors and non-survivors were compared to identify factors associated with 30-day all-cause mortality. Results: Postoperative AKI occurred in 91 of 128 patients (71.1%), and 16 patients (17.6%) required continuous renal replacement therapy. Univariate analysis showed that preoperative neutrophil-to-lymphocyte ratio (NLR) stratification, aortic cross-clamp time, postoperative day 1 (POD1) serum creatinine, POD1 estimated glomerular filtration rate (eGFR), duration of mechanical ventilation, length of intensive care unit (ICU) stay, and perioperative albumin-related indicators were associated with postoperative AKI (all P<0.05). Multivariate logistic regression demonstrated that perioperative albumin-related indicators were significantly associated with postoperative AKI [odds ratio (OR) =1.013, 95% confidence interval (CI): 1.003-1.022, P=0.01]. However, these indicators are more likely to reflect underlying disease severity, capillary leakage, volume status, and perioperative physiological instability rather than represent direct causal factors for AKI. Among patients who developed AKI, preoperative NLR >20, early postoperative renal dysfunction, and albumin-related indicators were associated with 30-day all-cause mortality (all P<0.05). Conclusions: AKI remains a common complication following Sun's procedure for ATAAD. Preoperative inflammatory status, prolonged aortic cross-clamp time, and perioperative albumin-related indicators may serve as markers indicating a higher risk of AKI, whereas elevated preoperative NLR, early postoperative renal dysfunction, and albumin-related indicators are associated with poor short-term outcomes among patients with AKI. These findings may contribute to perioperative risk stratification and early clinical decision-making in this high-risk population.