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The risk factors of postoperative hypoxemia in patients with Stanford type A acute aortic dissection.

ABSTRACT: Hypoxemia is one of the most common complications in patients after Stanford type A acute aortic dissection surgery. The aim of this study was to investigate the association of circulating ANG II level with postoperative hypoxemia and to identify the risk factors for postoperative hypoxemia in Stanford type A acute aortic dissection patients. In this study, 88 patients who underwent Stanford type A acute aortic dissection surgery were enrolled. Postoperative hypoxemia is defined by the oxygenation index (OI). Perioperative clinical data were collected and the serum ANG II and sACE2 levels were measured. The differences in the basic characteristics, intraoperative details, biochemical parameters, laboratory test data and clinical outcomes were compared between the hypoxemia group and the non-hypoxemia group by univariate analysis. Multivariate logistic regression analysis was performed on the variables with P < .1 in univariate analysis or that were considered clinically important to identify risk factors for postoperative hypoxemia. Twenty-five patients (28.4%) were considered to have postoperative hypoxemia (OI ≤ 200 mm Hg). The ANG II concentration remained a risk factor associated with postoperative hypoxemia [OR = 1.018, 95% CI (1.003-1.034), P = .022]. The other risk factors remaining in the logistic regression model were BMI [OR = 1.417, 95% CI (1.159-1.733), P = .001] and cTnI [OR = 1.003, 95% CI (1.000-1.005), P = .032]. Elevated levels of ANG II, BMI and cTnI are risk factors for postoperative hypoxemia in patients with Stanford type A acute aortic dissection.

SUBMITTER: Wang X

PROVIDER: S-EPMC10443739 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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The risk factors of postoperative hypoxemia in patients with Stanford type A acute aortic dissection.

Wang Xu'an X Ma Jun J Lin Duomao D Dong Xiuhua X Wu Jinjing J Bai Yang Y Zhang Dongni D Gao Junwei J

Medicine 20230801 33

Hypoxemia is one of the most common complications in patients after Stanford type A acute aortic dissection surgery. The aim of this study was to investigate the association of circulating ANG II level with postoperative hypoxemia and to identify the risk factors for postoperative hypoxemia in Stanford type A acute aortic dissection patients. In this study, 88 patients who underwent Stanford type A acute aortic dissection surgery were enrolled. Postoperative hypoxemia is defined by the oxygenati ...[more]

PMID: 37603505

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Project description:BackgroundHypoxemia is a common complication after Stanford type A acute aortic dissection surgery (AADS), however, few studies about hypoxemia after AADS exist. The aims of this study were to identify independent risk factors for hypoxemia after AADS and to clarify its association with clinical outcomes.MethodsPatients undergoing AADS from 2016 to 2019 in our hospital were identified and used as a training set. Preoperative variables were first screened by univariate analysis and then entered into a multivariate logistic regression analysis to identify independent risk factors. A nomogram and an online risk calculator were constructed based on the logistic model to facilitate clinical practice and was externally validated in an independent dataset.ResultsSevere hypoxemia developed in 119 of the 492 included patients (24.2%) and poorer clinical outcomes were observed in these patients. Five independent risk factors for severe hypoxemia after AADS were identified by multivariate analysis, including older age, smoking history, renal insufficiency, higher body mass index, and white blood cell count. The model showed good calibration, discrimination, and clinical utility in the training set, and was well validated in the validation set. Risk stratification was performed and three risk groups were defined as low, medium, and high risk groups. Hypertension was identified as an independent risk factor for moderate hypoxemia besides the five predictors mentioned above, and renal insufficiency was not significant for mild hypoxemia by multivariate analysis. In addition, although frozen elephant trunk was associated with increased risk of postoperative hypoxemia in the univariate analysis, frozen elephant trunk was also not identified as an independent risk factor for postoperative hypoxemia in the multivariate analysis.ConclusionHypoxemia was frequent following AADS, related to poorer clinical outcomes. Predictors were identified and a nomogram as well as an online risk calculator predicting severe hypoxemia after AADS was developed and validated, which may be helpful for risk estimation and perioperative management.

Project description:BackgroundThe correlation between rhabdomyolysis and postoperative acute kidney injury has been reported in several surgical procedures. As a good predictor of rhabdomyolysis-related acute kidney injury, an elevated serum myoglobin level was often observed after total aortic arch replacement combined with frozen elephant trunk implantation. However, the correlation between serum myoglobin and acute kidney injury in such patients had not been established.MethodsTotally 398 stanford type A aortic dissection patients who underwent total aortic arch replacement combined with frozen elephant trunk implantation were enrolled in this retrospective study. The correlations between serum myoglobin and acute kidney injury as well as the 30-day mortality were assessed.ResultsOverall, 268(67.3%) patients had acute kidney injury (KDIGO stage 1 or higher) and 75(18.8%) had severe acute kidney injury (KDIGO stage 2&3). Patients who developed acute kidney injury had higher level of perioperative serum myoglobin than patients without acute kidney injury. After adjusting for known acute kidney injury risk factors, logarithmically transformed preoperative serum myoglobin [OR = 1.58 (95% CI, 1.26-1.95), P < 0.001] and postoperative day 1 serum myoglobin [OR = 3.47 (95%CI, 2.27-5.29), P < 0.001] were associated with severe acute kidney injury. These correlation persisted after adjustment for decline in filtration via change in serum creatinine (ΔCr) and biomarkers of cardiac and kidney injury, including N-terminal prohormone of brain natriuretic peptide, cardiac troponin I, creatine kinase-MB, serum creatinine and Cystatin C. Compared with the clinical model, sMb considerably improved the risk discrimination and reclassification for AKI.ConclusionFor stanford type A aortic dissection patients underwent total aortic arch replacement with frozen elephant trunk implantation, serum myoglobin can improve postoperative acute kidney injury risk classification. Rhabdomyolysis may be an important supplement to the existing knowledge on the mechanism of acute kidney injury.

Project description:BackgroundPre-operative and post-operative hypoxemia are frequent complications of Stanford type A aortic dissection (AAD). This study explored the effect of pre-operative hypoxemia on the occurrence and outcome of post-operative acute respiratory distress syndrome (ARDS) in AAD.MethodA total of 238 patients who underwent surgical treatment for AAD between 2016 and 2021 were enrolled. Logistic regression analysis was conducted to investigate the effect of pre-operative hypoxemia on post-operative simple hypoxemia and ARDS. Post-operative ARDS patients were divided into pre-operative normal oxygenation group and pre-operative hypoxemia group that were compared for clinical outcomes. Post-operative ARDS patients with pre-operative normal oxygenation were classified as the real ARDS group. Post-operative ARDS patients with pre-operative hypoxemia, post-operative simple hypoxemia, and post-operative normal oxygenation were classified as the non-ARDS group. Outcomes of real ARDS and non-ARDS groups were compared.ResultLogistic regression analysis showed that pre-operative hypoxemia was positively associated with the risk of post-operative simple hypoxemia (odds ratios (OR) = 4.81, 95% confidence interval (CI): 1.67-13.81) and post-operative ARDS (OR = 8.514, 95% CI: 2.64-27.47) after adjusting for the confounders. The post-operative ARDS with pre-operative normal oxygenation group had significantly higher lactate, APACHEII score and longer mechanical ventilation time than the post-operative ARDS with pre-operative hypoxemia group (P < 0.05). Pre-operative the risk of death within 30 days after discharge was slightly higher in ARDS patients with pre-operative normal oxygenation than in ARDS patients with pre-operative hypoxemia, but there was no statistical difference(log-rank test, P = 0.051). The incidence of AKI and cerebral infarction, lactate, APACHEII score, mechanical ventilation time, intensive care unit and post-operative hospital stay, and mortality with 30 days after discharge were significantly higher in the real ARDS group than in the non-ARDS group (P < 0.05). After adjusting for confounding factors in the Cox survival analysis, the risk of death within 30 days after discharge was significantly higher in the real ARDS group than in the non-ARDS group (hazard ratio(HR): 4.633, 95% CI: 1.012-21.202, P < 0.05).ConclusionPreoperative hypoxemia is an independent risk factor for post-operative simple hypoxemia and ARDS. Post-operative ARDS with pre-operative normal oxygenation was the real ARDS, which was more severe and associated with a higher risk of death after surgery.

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The risk factors of postoperative hypoxemia in patients with Stanford type A acute aortic dissection.

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The risk factors of postoperative hypoxemia in patients with Stanford type A acute aortic dissection.

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