Prognostic Value of Preoperative Ascending Aortic Diameter on Postoperative Acute Kidney Injury in Adult Cardiac Surgery

Background: Ascending aortic diameter (AAD) is commonly measured during ultrasound examinations in cardiac surgery patients and is critical for assessing their prognosis. AAD affects renal perfusion. However, the impact of AAD on the incidence of postoperative acute kidney injury (AKI) in cardiac surgery patients remains unclear. This study aims to explore the prognostic value of AAD for postoperative AKI in adult cardiac patients. Methods: This retrospective study included patients aged >= 18 years who underwent cardiovascular surgeries from April to July 2023 at Fuwai Hospital, China. Patients were categorized into two groups: the AKI group and the non-AKI group. Preoperative cardiac ultrasound values were collected the day before surgery. The primary endpoint was the incidence of AKI. Univariable and multivariable logistic regression analyses were conducted to identify independent risk factors for postoperative AKI. The receiver operating characteristic curve was utilized to evaluate model performance. The effectiveness of including AAD in the model was also assessed. Results: The study comprised 442 patients. Both univariable and multivariable analyses indicated that AAD is an independent predictor of postoperative AKI in both on-pump and off-pump cardiac patients (p < 0.05). To control for the confounding factor of cardiopulmonary bypass (CPB) time, a subgroup analysis was conducted, which showed that including AAD improved the area under the curve (AUC) from 0.67 to 0.72 (p <0.05) in on-pump patients. Conclusion: AAD is a significant prognostic factor for postoperative AKI in adult cardiac surgery. Its prognostic value is particularly pronounced in on-pump patients. Patients with an enlarged AAD are at a higher risk of developing AKI and experiencing adverse outcomes.