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Research article
Ming Bai
Xijing Hospital
Corresponding Author
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View the published article at Journal of Cardiothoracic Surgery.
Background: Hyperbilirubinemia 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.
Methods: Patients 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.
Results: After 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.
Conclusions: Severe 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.
Keywords
Stanford type A aortic dissection, hyperbilirubinemia, acute kidney injury, continuous renal replacement therapy
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CURRENT STATUS: Published
Version 2
Posted 06 Jul, 2020
Published
On 28 Jul, 2020
No community comments so far
Editorial decision: Accept
On 18 Jul, 2020
Editor assigned
On 02 Jul, 2020
Submission checks complete
On 01 Jul, 2020
Editor invited
On 01 Jul, 2020
No comments provided
Editorial decision: Major revision
On 13 Jun, 2020
Review #1 received
Received 07 Jun, 2020
Review #2 received
Received 06 Jun, 2020
Reviewer #2 agreed
On 25 May, 2020
Reviewer #1 agreed
On 24 May, 2020
Reviewers invited
Invitations sent on 24 May, 2020
Editor assigned
On 21 May, 2020
First submitted
On 20 May, 2020
Submission checks complete
On 20 May, 2020
Editor invited
On 20 May, 2020
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Subject Areas
Cardiothoracic Surgery
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This preprint is under consideration at Journal of Cardiothoracic Surgery. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Ming Bai
Xijing Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 06 Jul, 2020
Published
On 28 Jul, 2020
No community comments so far
Editorial decision: Accept
On 18 Jul, 2020
Editor assigned
On 02 Jul, 2020
Submission checks complete
On 01 Jul, 2020
Editor invited
On 01 Jul, 2020
No comments provided
Editorial decision: Major revision
On 13 Jun, 2020
Review #1 received
Received 07 Jun, 2020
Review #2 received
Received 06 Jun, 2020
Reviewer #2 agreed
On 25 May, 2020
Reviewer #1 agreed
On 24 May, 2020
Reviewers invited
Invitations sent on 24 May, 2020
Editor assigned
On 21 May, 2020
First submitted
On 20 May, 2020
Submission checks complete
On 20 May, 2020
Editor invited
On 20 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cardiothoracic Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Journal of Cardiothoracic Surgery.
Background: Hyperbilirubinemia 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.
Methods: Patients 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.
Results: After 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.
Conclusions: Severe 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.
Figure 1
Figure 2
Figure 3
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