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℃, P= .005), higher levels of CRP (42.70±28.27 vs 13.90±18.70mg/L, P= .000) and procalcitonin (1.07±3.92 vs 0.31±0.77ug/L, P= .027), and lower levels of albumin (34.21±5.65 vs 37.73±4.70g/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.

The Preoperative Uric Acid-to-Albumin Ratio as a New Indicator to Predict Long-Term Prognosis After Surgery for Patients with Acute Type A Aortic Dissection

“…Many studies have shown that SA is likely protection factors to be the type A AAD, type A AAD occurs, a large number of inflammatory cytokines release, increase SA decomposition, led to lower SA, blood vessels in the colloid osmotic pressure drop, cause oedema after large amounts of fluid leakage, causing the blood volume is reduced, viscera perfusion decreased, AKI, pulmonary edema, cerebral edema and other serious complications can further affect the postoperative outcome of patients with Type A AAD. Low SA reduces the ability of scavenging oxygen-free radicals and inhibiting inflammatory response, and endothelial cells are damaged, and the elasticity of aortic vascular wall decreases, ultimately affecting the outcome of Type A AAD [Keskin 2021;Gao 2019;Zhao 2020;Weiner 2011].…”

Preoperative Uric Acid-to-albumin Ratio as a New Indicator for Predicting Long-term Prognosis in Patients With Acute Type a Aortic Dissection

“…Low SA reduces the ability of scavenging oxygen free radicals and inhibiting in ammatory response, and endothelial cells are damaged, and the elasticity of aortic vascular wall decreases. Ultimately affecting the outcome of Type A AAD [18,19].…”

Intestinal barrier dysfunction is involved in the development of systemic inflammatory responses and lung injury in type A aortic dissection: a case-control study

“…IL-6, TNFα, and CRP are common pro-inflammatory cytokines that have been reported as overexpressed in patients with aortic dissection (3)(4)(5)(6)(7)(8)(9)(10). Studies found that inflammatory cytokines, including CRP, IL-6, and IL-8, might be associated with the development of acute lung injury in patients with acute TAAD (5,14,(18)(19)(20)(21), and WBC levels could be elevated in these patients (5,18). In this study, we found that various inflammatory response indicators, including WBC parameters and inflammatory cytokines, were activated in patients with TAAD and significantly higher than in those in patients with ARA.…”