Plasma levels of receptor-interacting protein kinase 3 is associated with postoperative acute kidney injury in acute DeBakey type I aortic dissection

Abstract

Background: Postoperative acute kidney injury (AKI) in acute DeBakey type I aortic dissection (ADIAD) is common but has unclear pathogeneses and limited treatments. Receptor-interacting protein kinase 3 (RIP3), a mediator of necroptosis, is associated with human sepsis-induced and posttraumatic AKI, but its role in human postoperative AKI in ADIAD remains unclear. We assumed that RIP3 levels is associated with postoperative AKI in ADIAD. Methods: Plasma samples and the clinical data of continuous patients with ADIAD were collected prospectively. The patients were divided into three groups according to AKI stage postoperatively. The plasma RIP3 levels were compared among the groups, and the relationship between RIP3 and serum creatinine (sCr), inflammatory cytokines as well as clinical results were analyzed. Results: Eighty patients were enrolled. The postoperative and elevated RIP3 levels among the three groups were significantly different (P < 0.0001), both with a positive trend across the AKI stage (P for trend < 0.001), and they were also independent risk factors for postoperative AKI in ADIAD (OR = 1.018 and 1.026, P < 0.05). The postoperative RIP3 levels were positively correlated with the aortic crossclamp time (R = 0.253, P < 0.05); the peak values of sCr, procalcitonin, interleukin-6 and lactate postoperatively; the mechanical ventilation time; and the ICU stay time (R = 0.66, 0.369, 0.409, 0.397, 0.474 and 0.435, respectively; all P < 0.001). Plasma RIP3 level and sCr were comparable in diagnosing postoperative AKI in ADIAD (P = 0.898), and higher postoperative RIP3 level was associated with lower survival rate. Conclusion: The plasma RIP3 levels are associated with postoperative AKI, inflammatory response and clinical outcomes in ADIAD.