IMR Press / RCM / Volume 23 / Issue 11 / DOI: 10.31083/j.rcm2311363
Open Access Original Research
Toll-Like Receptor 4 Is an Early and Sensitive Biomarker to Detect Acute Kidney Injury after Surgery for Type A Aortic Dissection
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1 Department of Nephrology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 210008 Nanjing, Jiangsu, China
2 Department of Cardio-thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, 210008 Nanjing, Jiangsu, China
3 Department of Nephrology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, 210008 Nanjing, Jiangsu, China
*Correspondence: (Hengjin Wang); (Chunming Jiang); (Dongjin Wang)
These authors contributed equally.
Academic Editor: Alessandro Cataliotti
Rev. Cardiovasc. Med. 2022, 23(11), 363;
Submitted: 1 August 2022 | Revised: 29 August 2022 | Accepted: 14 September 2022 | Published: 25 October 2022
(This article belongs to the Section CardioRenal)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Acute kidney injury (AKI) is a relatively common complication after surgery for type A acute aortic dissection (ATAAD) and is associated with a poor prognosis. Preclinical models suggest that toll-like receptor 4 (TLR4) may participate in the pathogenesis of AKI. However, the correlation of serum TLR4 and post-operative AKI has not been studied in ATAAD patients. This study aimed to explore the possibility of using serum TLR4 levels to predict AKI and 30-day mortality in patients undergoing ATAAD surgery. Methods: A prospective, single-center cohort study was conducted and enrolled a total of 64 patients undergoing ATAAD surgery. The level of serum TLR4 was measured and compared before and within 24 hours after the completion of surgery. Results: Thirty-five (54.7%) patients developed AKI, including 7 (10.9%) diagnosed with severe AKI (Kidney Disease Improving Global Outcomes (KDIGO) stage 3). TLR4 levels at 0-hour,1-hour, 3-hour, and 6-hour after intensive care unit (ICU) admission were significantly different between patients with or without AKI. Further analysis showed that the difference was most significant at 0-hour after ICU admission which corresponded to an area under the curve (AUC) of 0.886 (95% confidence interval (CI), 0.800 to 0.973). For severe AKI, the AUC of TLR4 was the highest with 0.923 (0.852 to 0.995) at 1-hour after ICU admission. TLR4 levels before surgery and at 0-hour, 1-hour, as well as 3-hour after ICU admission were significantly different between survivors and non-survivors. Furthermore, we found that the serum level of TLR4 upon ICU admission could be used to predict the 30-day mortality with AUC of 0.805 (0.648 to 0.962). Conclusions: Serum TLR4 levels can be used as a biomarker to predict the occurrence of AKI and 30-day mortality in patients undergoing ATAAD surgery. Clinical Trial Registration Number: ChiCTR2200057197.

toll-like receptor 4
acute kidney injury
aortic dissection
30-day mortality
risk factor
ZKX16040/Key Project of Nanjing Medical Science and Technology Development
Fig. 1.
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