Predictors for the development of preoperative oxygenation impairment in acute aortic dissection in hypertensive patients

Abstract

Background: Acute aortic dissection (AAD) is an acute life-threatening cardiovascular disease, which is frequently complicated with oxygenation impairment (OI). We aim to investigate predictors of the development of OI in the patients with AAD. Methods: We retrospectively collected clinical data of AAD in hypertensive patients from July 2012 to March 2020. The patients included in this study were divided into OI (+) group (oxygenation index≤200) and OI (−) group (oxygenation index> 200). Both groups were compared according to demographic and clinical characteristics, and laboratory findings. Characteristics of hypertension in the patients with AAD were described. Predictors for the development of OI were assessed. And cutoff values were determined by receiver operating characteristics (ROC) curve. Results: A total of 208 patients were included in this study and the incidence of OI was 32.2%. In OI (+) group, patients had significantly higher peak body temperature (37.85 ± 0.60 vs 37.64 ± 0.44°C, P = .005), higher levels of CRP (42.70 ± 28.27 vs 13.90 ± 18.70 mg/L, P = .000) and procalcitonin (1.07 ± 3.92 vs 0.31 ± 0.77μg/L, P = .027), and lower levels of albumin (34.21 ± 5.65 vs 37.73 ± 4.70 g/L, P = .000). Spearman's rank correlation test showed that the minimum oxygenation index was positively correlated with albumin, and was negatively correlated with the peak body temperature, serum CRP, procalcitonin, BNP and troponin. The stepwise multiple linear regression analysis showed that the peak body temperature, serum CRP and albumin were independently associated with development of OI. An optimal cutoff value for CRP for predicting OI was ≥9.20 mg/L, with a sensitivity of 91.0% and a specificity of 61.0%. Conclusions: The peak body temperature, serum CRP and albumin were independent predictors of OI development in the patients with AAD. The serum CRP on admission≥9.20 mg/L might be a valuable and reliable indicator in predicting the development of OI.

Predictors of hypoxemia in type-B acute aortic syndrome: a retrospective study

“…The following categories of patients were excluded: emergent surgery within 24 h of onset, onset time unknown, diagnosis later than 7 days after onset, acute heart failure, and infectious pneumonia. In previous studies, almost all hypoxemia events have been within 7 days, and about 80% of them have occurred within 3 days 6 , 12 . Therefore, to avoid underestimating hypoxemia events, we excluded patients who had diagnosis later than 7 days after onset.…”

“…The underlying mechanism of hypoxemia in AAS is not yet known, but in previous reports, it has been attributed to systemic inflammation 4 , 18 – 20 . Elevated CRP level, an inflammatory marker, has been reported to be related to lung oxygenation impairment in patients with AAS 5 , 12 , 13 , 18 , 19 . Those studies explained that the CRP level is correlated with hypoxemia through the production of inflammatory cytokines, such as interleukin (IL) -6 and IL-8.…”

“…In past reports on the risk of hypoxemia, the peak CRP level was most frequently cited as a predictor 5 , 12 , 13 , 18 , 19 . However, the peak CRP level after hospitalization is not known at the time of admission.…”

“…While there are several reports of perioperative hypoxemia in patients with type-A AAS, there are only a few reports of hypoxemia in patients with type-B AAS 4 – 6 , and hypoxemia is difficult to predict in patients with type-B AAS. Several studies have reported that the peak level of C-reactive protein (CRP) is useful for predicting hypoxemia 4 , 12 , 13 . However, the peak CRP level is not known at the onset of AAS; thus, it cannot be used for risk stratification for hypoxemia at the time of admission.…”

Evaluating the Direct Economic Burden of Prolonged Mechanical Ventilation Among Patients With Acute Type A Aortic Dissection: a Propensity Score-matched Cohort Analysis

“…Compared with other cardiovascular diseases, AAAD patients are more prone to perioperative hemodynamic instability and postoperative complications. For example, postoperative respiratory dysfunction is common, usually caused by systemic in ammation [4] and ischemia-reperfusion injury [5]. Thus, some patients require prolonged mechanical ventilation (PMV).…”