Table 1. Baseline characteristics of the included patients
|
Variables
|
Value
|
Preoperative
|
|
Age, mean ± SD (years )
|
49.1 ± 11.0
|
Male, n (%)
|
223 (82.3%)
|
Co-morbidity
|
|
Hypertension, n (%)
|
158 (58.3%)
|
Diabetes, n (%)
|
3 (1.1%)
|
Cerebrovascular disease, n (%)
|
16 (5.9%)
|
Previous cardiac surgery, n (%)
|
8 (2.9%)
|
APECHEII score, mean ± SD
|
9.2 ± 3.2
|
MELD score, mean ± SD
|
9.2 ± 4.1
|
SOFA score, mean ± SD
|
2.1 ± 1.5
|
MAP, mean ± SD (mm/Hg)
|
90.5 ± 12.9
|
TB, mean ± SD (μmol/l)
|
25.0 ± 15.0
|
CB, mean ± SD (μmol/l)
|
7.8 ± 8.1
|
WBC, mean ± SD (109/l)
|
11.7 ± 5.0
|
Hb, mean ± SD (g/l)
|
136.1 ± 19.9
|
PLT, mean ± SD (109 /l)
|
157.2 ± 68.5
|
SCr, mean ± SD (μmol/l)
|
111.1 ± 38.3
|
PT, mean ± SD (s)
|
12.0 ± 2.2
|
Intraoperative
|
|
Type of operation
|
|
Aortic valve, n (%)
|
227 (83.8%)
|
Aortic arch, n (%)
|
233 (86%)
|
Coronary artery, n (%)
|
46 (17%)
|
Operation duration, mean ± SD (h)
|
6.8 ± 1.6
|
CPB time, mean ± SD (min)
|
226.5 ± 60.9
|
ACC time, mean ± SD (min)
|
102.2 ± 28.0
|
The amount of blood transfusion (U)
|
18.8 ± 10.6
|
Postoperative
|
|
APECHE II score
|
16.9±2.5
|
SOFA score
|
12.1±2.6
|
Meld score
|
18.6±4.4
|
AST, mean ± SD (U /L)
|
347.6±1387.2
|
ALT, mean ± SD (U/L)
|
164.4±526.6
|
TB, mean ± SD (μmol /l)
|
189.1±74.6
|
CB, mean ± SD (μmol /l)
|
110.7±37.9
|
WBC, mean ± SD (109/l)
|
12.9±4.8
|
Hb, mean ± SD (g/l)
|
112.9±16.6
|
PLT, mean ±SD (109 /l)
|
99.8±49.5
|
SCr, mean± SD (μmol/l)
|
162.8±71.8
|
PT, mean± SD (s)
|
13.6±2.9
|
Peak TB level, mean ± SD (μmol/l)
|
150.9 ± 93.0
|
Peak TB level > 171μmol/l, n (%)
|
55 (20.4%)
|
Peak TB level > 340μmol/l, n (%)
|
12 (4.4%)
|
Time to peak TB level, mean ± SD (d)
|
3.8 ± 3.0
|
Time to peak TB level > 5 d, n (%)
|
47 (17.4%)
|
ACC, Aortic cross clamp; APECHEII, acute physiology and chronic health evaluation II; CB, conjugated bilirubin; CPB, cardiopulmonary bypass; Hb, hemoglobin; MAP, mean arterial pressure; MELD, model for end-stage liver disease; min, minute; PLT, platelet; PT, prothrombin time; SCr, serum creatinine; SD, standard deviation; SOFA, sequential organ failure assessment; TB, total bilirubin; WBC, white blood cell.
Table 2. The major outcomes of the included patients
Variables
|
Value
|
In-hospital mortality, n (%)
|
82 (30.3%)
|
Reoperation, n (%)
|
17 (6.3%)
|
AKI, n (%)
|
222 (81.9%)
|
Stage of AKI
|
|
Stage 1, n (%)
|
102 (40.2%)
|
Stage 2, n (%)
|
34 (12.5%)
|
Stage 3, n (%)
|
84 (29.2%)
|
Use of CRRT, n (%)
|
50 (18.5%)
|
Use of PE/BA, n (%)
|
11 (14.1%)
|
Use of IABP, n (%)
|
1 (0.4%)
|
Use of ECMO, n (%)
|
7 (2.6%)
|
Use of vasoactive agent, n (%)
|
173 (63.8%)
|
Mechanical ventilation time, mean ± SD (days)
|
3.3 ± 5.7
|
The amount of blood transfusion, mean ± SD (U)
|
34.8 ± 43.3
|
In hospital time, mean ± SD (days)
|
19.8 ± 10.7
|
ICU stay time, mean ± SD (days)
|
6.6 ± 6.3
|
Onset of severe hyperbilirubinemia, mean ± SD (days)
|
2.8 ± 1.3
|
AKI, acute kidney injury; BA, bilirubin adsorption; CRRT, continuous renal replacement therapy; ECMO, extracorporeal membrane oxygenation; IABP, intra-aortic balloon pump; ICU, intensive care unit; PE, plasma exchange.
Table 3. Logistic regression analysis for postoperative AKI and CRRT
Characteristic
|
Univariate logistic regression
|
Multivariate logistic regression
|
OR (95%CI)
|
P value
|
OR (95%CI)
|
P value
|
Postoperative AKI
|
|
|
|
|
Age
|
1.061 (1.032 - 1.092)
|
<0.001
|
1.056 (1.026 - 1.088)
|
<0.001
|
Hypertension (yes/no)
|
2.766 (1.469 - 5.208)
|
0.002
|
|
|
Preoperative
|
|
|
|
|
SCr
|
1.030 (1.014 - 1.047)
|
<0.001
|
1.026 (1.010 - 1.043)
|
0.002
|
APECHE II score
|
1.399 (1.213 - 1.615)
|
<0.001
|
|
|
MELD score
|
1.130 (1.035 - 1.233)
|
0.007
|
|
|
Operation duration
|
1.346 (1.089 - 1.633)
|
0.006
|
|
|
CPB time
|
1.008 (1.001 - 1.014)
|
0.015
|
1.007 (1.000 - 1.013)
|
0.042
|
Postoperative CRRT
|
|
|
Male (yes/no)
|
4.006 (1.192 - 13.462)
|
0.025
|
|
|
Preoperative
|
|
|
|
|
SCr
|
1.011 (1.003 - 1.018)
|
0.004
|
1.009 (1.002 - 1016)
|
0.017
|
APECHE II score
|
1.333 (1.033 - 1.244)
|
0.008
|
|
|
MELD score
|
1.083 (1.007 - 1.164)
|
0.032
|
|
|
ACC time
|
1.011 (1.000 - 1.022)
|
0.049
|
|
|
ACC, aortic cross clamp; AKI, acute kidney injury; APECHEII, acute physiology and chronic health evaluation II; CPB, cardiopulmonary bypass; CRRT, continuous renal replacement therapy; MELD, model for end-stage liver disease; SCr, serum creatinine
Table 4. Logistic regression analysis for in-hospital mortality
In-hospital mortality
|
Univariate logistic regression
|
Multivariate logistic regression (model 1)
|
Multivariate logistic regression (model 2)
|
Characteristic
|
OR (95%CI)
|
P value
|
OR (95%CI)
|
P value
|
OR (95%CI)
|
Pvalue
|
Age (yes/no)
|
1.035 (1.009 - 1.062)
|
0.008
|
1.005 (1.004 - 1.099)
|
0.033
|
1.046 (1.002 - 1.093)
|
0.040
|
Male (yes/no)
|
2.483 (1.106 - 5.575)
|
0.027
|
|
|
|
|
Preoperative
|
|
|
|
|
|
|
SCr
|
1.009 (1.002 - 1.016)
|
0.008
|
|
|
|
|
APECHE II score
|
1.178 (1.082 - 1.282)
|
<0.001
|
|
|
|
|
Intraoperative
|
|
|
|
|
|
|
CPB time
|
1.007 (1.003 - 1.011)
|
0.002
|
|
|
|
|
ACC time
|
1.012 (1.002 - 1.021)
|
0.014
|
|
|
|
|
Postoperative
|
|
|
|
|
|
|
MAP
|
0.948 (0.926 - 0.971)
|
<0.001
|
0.955 (0.922 - 0.990)
|
0.012
|
0.963 (0.930 - 0.977)
|
0.031
|
Re-operation (yes/no)
|
3.611 (1.324 - 9.852)
|
0.012
|
|
|
|
|
The total amount of blood transfusion
|
1.046 (1.032 - 1.060)
|
<0.001
|
1.018 (1.003 - 1.033)
|
0.019
|
1.020 (1.005 – 1.034)
|
0.007
|
Mechanical ventilation time
|
1.533 (1.341 - 1.798)
|
<0.001
|
|
|
|
|
AKI (yes/no)
|
28.350 (3.842 - 209.203)
|
0.001
|
|
|
|
|
Stage of AKI
|
|
<0.001
|
|
<0.001
|
|
<0.001
|
Stage 1
|
5.859 (0.735 - 46.720)
|
0.095
|
2.424 (0.267 - 21.990)
|
0.431
|
2.218 (0.253 - 19.426)
|
0.472
|
Stage 2
|
10.138 (1.162 - 88.457)
|
0.036
|
4.560 (0.478 - 43.545)
|
0.187
|
3.698 (0.385 – 35.548)
|
0.257
|
Stage 3
|
165.053 (21.354 - 1275.729)
|
<0.001
|
46.134 (5.436 - 391.525)
|
<0.001
|
46.318 (5.666 – 378.663)
|
46.318
|
Use of CRRT (yes/no)
|
23.756 (10.359 - 54.481)
|
0.001
|
|
|
|
|
Use of PE/BA (yes/no)
|
11.527 (2.432 - 54.631)
|
0.002
|
|
|
|
|
Use of ECMO (yes/no)
|
14.842 (1.757 - 125.357)
|
0.013
|
20.795 (1.620 - 266.917)
|
0.02
|
10.130 ( 0.900 – 113.958)
|
0.061
|
Peak TB concentration
|
1.009 (1.005 - 1.012)
|
<0.001
|
1.017 (1.002 - 1.032)
|
0.023
|
|
|
Peak TB ≥121μmol/l, (yes/no)
|
3.899 (2.220 – 6.847)
|
<0.001
|
|
|
2.681 (1.119 – 6.425)
|
0.027
|
Peak TB >171μmol/l, (yes/no)
|
3.785 (2.045 - 7.005)
|
<0.001
|
|
|
|
|
Time to peak TB concentration
|
1.441 (1.277 - 1.626)
|
<0.001
|
|
|
|
|
ICU stay time
|
1.268 (1.172 - 1.371)
|
<0.001
|
|
|
|
|
Model 1 was established by analysis of peak TB concentration; Model 2 was established by subgroup analysis of peak bilirubin concentration greater or less than 121.2 µmol/l
ACC, aortic cross clamp; AKI, acute kidney injury; APECHEII, acute physiology and chronic health evaluation II; BA, bilirubin adsorption; CPB, cardiopulmonary bypass; CRRT, continuous renal replacement therapy; ECMO, extracorporeal membrane oxygenation; ICU, intensive care unit; MAP, mean arterial pressure; PE, plasma exchange; SCr, serum creatinine; TB, total bilirubin