Characteristics and outcomes of Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia: a retrospective cohort study

Abstract

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 cutoff value of peak TB on predicting in-hospital mortality was 121.2 μmol/L. Patients with postoperation 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.

Time to peak bilirubin concentration and advanced AKI were associated with increased mortality in rheumatic heart valve replacement surgery patients with severe postoperative hyperbilirubinemia: a retrospective cohort study

“…The severe hyperbilirubinemia after HVS for RHD might be caused by the severity of the RHD itself and HVS injuries. The causes of poor prognosis have been described in our previous study [ 15 ]. In short, hyperbilirubinemia has been shown to promote apoptosis and aggravate renal ischemia–reperfusion injury in animal models [ 22 ].…”

“…Therefore, they considered that early mild postoperative hyperbilirubinemia might be caused by hemolysis, hypothermia, and hypotension during CPB surgery [ 37 ]. However, late severe postoperative hyperbilirubinemia was most likely related to liver dysfunction and resulted in poor prognosis, and the occurrence of liver dysfunction might be caused by persistent cardiac failure or sepsis[ 9 , 15 ]. Therefore, monitoring heart function and maintaining hemodynamic stability after HVS for RHD are of great concern to prevent further deterioration.…”

“…Urine output on every postoperative day and blood pressure on the first day after the surgery were also recorded. Moreover, consistent with our previous research, the acute physiology and chronic health evaluation II (APACHE II) score, European system for cardiac operative risk evaluation II (EuroSCORE II), model for end-stage liver disease (MELD) score, and sequential organ failure assessment (SOFA) score were calculated to assess the severity of the disease [ 15 ].…”

“…Relation analysis and collinearity diagnosis were also performed, and only one of the variables with a significant correlation was included in the multivariate regression analysis. Similar to our previous studies, the Kaplan–Meier method was utilized to evaluate cumulative survival and the log-rank test was used to evaluate the differences between the two groups in the cumulative survival[ 15 ]. To further evaluate the effect of time to peak TB concentration on predicting patient in-hospital mortality, the area under curve of the receiver operating characteristic (AUC-ROC) was computed and the Youden index was employed to assess the optimal cutoff values of time to peak TB concentration.…”

“…Additionally, our previous study showed that the prognosis of patients with severe postoperative hyperbilirubinemia remains significantly different. Some patients recovered within a few weeks, while others progressed to MOF, which led to an increase in short-term mortality [ 15 ]. To explore of the characteristics, prognosis, and risk factors for in-hospital and long-term mortality is helpful for clinicians understand the prognosis for patients with severe postoperative hyperbilirubinemia, which is useful for patient consultation as well as decision making.…”