Characteristics and outcomes of Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia: a retrospective cohort study
Characteristics and outcomes of Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia: a retrospective cohort study
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斯坦福 A 型主动脉夹层术后重度高胆红素血症患者的特征和结局：一项回顾性队列研究
DOI：
10.1186/s13019-020-01243-7
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发表时间：
2020-07-28
影响因子：
1.6
通讯作者：
Chen, Xiangmei
中科院分区：
文献类型：
--
作者：
Chen, Xiaolan;Bai, Ming;Chen, Xiangmei
背景高胆红素血症是心脏手术后常见的并发症之一，与死亡率增加有关。然而，据我们所知，关于斯坦福大学A型主动脉夹层（AAD）患者术后严重高胆红素血症临床意义的报道有限。将住院死亡率、长期死亡率、急性肾损伤（阿基）和连续性肾脏替代治疗（CRRT）需求作为终点进行评估。采用单变量和多变量回归模型来确定这些终点的危险因素。结果经过筛选，271名患者纳入本研究。在纳入的患者中，222例（81.9%）发生术后阿基，50例（18.5%）接受CRRT。住院病死率为30.3%。1年、2年和3年累积死亡率分别为32.9%、33.9%和35.3%。多因素Logistic回归分析显示，（P< 0.033），阿基3期（P< 0.001），术后输血量（P= 0.019），术后第1天平均动脉压（MAP）（P= 0.012），使用体外膜肺氧合（ECMO）（P= 0.02）、总胆红素（TB）峰值浓度（P= 0.023）是影响住院死亡率的独立危险因素。结核峰值预测住院死亡率的最佳截断值为121.2 μmol/L。术后TB ≥ 121 μmol/L的患者长期生存率也较低。在AAD患者中，术后重度高胆红素血症、年龄较大、MAP较低、输血增加、3阿基、ECMO的使用和TB峰值增加导致住院死亡率增加。
BackgroundHyperbilirubinemia is one of the common complications after cardiac surgery and is associated with increased mortality. However, to the best of our knowledge, the reports on clinical significance of postoperative severe hyperbilirubinemia in Stanford type A aortic dissection (AAD) patients were limited.MethodsPatients who underwent surgical treatment for AAD in our center between January 2015 and December 2018 were retrospectively screened. In-hospital mortality, long-term mortality, acute kidney injury (AKI), and the requirement of continuous renal replacement therapy (CRRT) were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of these endpoints.ResultsAfter screening, 271 patients were included in our present study. Of the included patients, 222 (81.9%) experienced postoperative AKI, and 50 (18.5%) received CRRT. The in-hospital mortality was 30.3%. The 1-year, 2-year, and 3-year cumulative mortality were 32.9, 33.9, and 35.3%, respectively. Multivariate Logistic regression analysis indicated that age (P< 0.033), AKI stage 3 (P< 0.001), the amount of blood transfusion after surgery (P= 0.019), mean arterial pressure (MAP) in the first postoperative day (P= 0.012), the use of extracorporeal membrane oxygenation (ECMO) (P= 0.02), and the peak total bilirubin (TB) concentration (P= 0.023) were independent risk factors of in-hospital mortality. The optimal cut-off value of peak TB on predicting in-hospital mortality was 121.2 μmol/L. Patients with post-operation TB ≥ 121 μmol/L was associated with worse long-term survival as well.ConclusionsSevere post-operation hyperbilirubinemia is a common clinical situation in patients had AAD repair. In AAD patients with severe post-operation hyperbilirubinemia, older age, lower MAP, increased blood transfusion, stage 3 AKI, the use of ECMO, and the increased peak TB lead to increase in-hospital mortality.