Risk factors for continuous renal replacement therapy after surgical repair of type A aortic dissection

Wu, Haibo; Ma, Wei-Guo; Zhao, Hulin; Zheng, Jun; Lǐ, Jiànróng; Liu, Ou; Sun, Lu

doi:10.21037/jtd.2017.03.128

Cited by 25 publications

(21 citation statements)

References 35 publications

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“…It is also a specific marker of the fibrinolytic system. D-dimer can be used as one of the indicators for monitoring inflammation and severe infection ( 17 ). Patients with MPP appear hypoxic.…”

Section: Discussionmentioning

confidence: 99%

Assessment of levels of D‑dimer and interferon‑γ in pediatric patients with Mycoplasma pneumoniae pneumonia and its clinical implication

et al. 2018

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Levels of D-dimer and interferon-γ (INF-γ) in pediatric patients with Mycoplasma pneumoniae pneumonia (MPP) were assessed to explore its clinical implication in evaluating the disease severity and patients' prognosis. Enrolled in this study as subjects were 185 pediatric patients with MPP who were admitted to the Department of Pediatrics of the Second Affiliated Hospital of Qiqihar Medical University and the First Hospital of Qiqihar City from January 2017 to October 2017 and 115 healthy children who underwent physical examination during the same time period. Patients were divided into two groups according to the severity of their pneumonia: Severe pneumonia group with 95 patients and mild pneumonia group with 90 patients. A total of 92 healthy children were assigned to the control group. Immunoassay was performed to measure the serum levels of D-dimer and INF-γ. The levels of these two markers were compared. In terms of D-dimer, the levels in pediatric patients in pneumonia groups were all higher than that in the healthy children (p<0.0001). After treatment for 120 h, the D-dimer and INF-γ levels in both pneumonia groups were lower than those before treatment (p<0.001). Among the patients in both the mild and severe pneumonia groups, those who developed extra-pulmonary complications had higher levels of D-dimer and INF-γ than those who did not developed extra-pulmonary complications (p<0.001). Increased levels of D-dimer and INF-γ were observed in pediatric patients with MPP. Assessment of the levels of D-dimer and INF-γ in serum may help with the diagnosis of severe MPP in children and predicting the occurrence of complications. This study provided more theoretical basis for the early diagnosis and identification of MPP in children, and can be used as a guideline in evaluating the severity and preventing complications.

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Section: Discussionmentioning

confidence: 99%

Assessment of levels of D‑dimer and interferon‑γ in pediatric patients with Mycoplasma pneumoniae pneumonia and its clinical implication

et al. 2018

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“…12) CPB time was also a risk factor for postoperative ARF and neurological dysfunction. 13,14) The only postoperative paraparesis occurred in SRTAD group in this study, which was a serious complication in aortic repair with stented elephant trunk implantation. 15) We thought the high rate of neurologic dysfunction in SRTAD group might be associated with the previous implanted stent since the management of the previous stent in the second intervention promoted embolus detachment or branch vessels embolization.…”

Section: Discussionmentioning

confidence: 59%

Surgical Outcomes of Stent-Related Type A Dissection Compared with Spontaneous Type A Dissection

Tan

et al. 2020

ATCS

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Objective: Aortic endovascular stent implantation includes thoracic endovascular aortic repair (TEVAR), hybrid aortic repair (HAR), and ascending aorta stent implantation (AASI). In this study, we compared the surgical outcomes of stent-related type A dissection (SRTAD) compared with spontaneous type A dissection (STAD). Methods: From July 2011 to July 2014, we identified 17 SRTAD patients received surgical repair in our institution. Propensity score-matching was used to identify 34 STAD patients as controls. Results: Preoperative data of SRTAD group and STAD group had no statistical difference. Selective cerebral perfusion (SCP) time was longer in SRTAD group than in STAD group (P <0.05). SRTAD group had a longer cross-clamp time compared with STAD group (P <0.05). No intraoperative deaths in two groups. No differences in CPB time and concomitant procedures between two groups. In-hospital mortality was 11.76% (2 of 17) in SRTAD group and 2.9% (1 of 34) in STAD group (P <0.05). No differences were found in intensive care unit (ICU) time, ventilation, paraparesis, and other postoperative complications between SRTAD and STAD groups. No difference was found in survival rate between SRTAD and STAD groups in the postoperative 1-year follow-up. Conclusions: SRTAD patients received surgical repair had a higher in-hospital mortality compared with STAD, but no differences were found in postoperative complications and mid-term outcomes.

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“…sCr level was identified as a risk factor for CRRT in our study, which shows a significant influence of elevations in the preoperative creatinine serum levels on postoperative renal function. Study from Wu's group also suggested that sCr level is a risk factor for CRRT after surgical repair of TA-AAD [13].…”

Section: Discussionmentioning

confidence: 96%

Independent Risk Factors and The Long-term Outcomes for Postoperative Continuous Renal Replacement Treatment in Patients Who Underwent Emergency Surgery for Type A Acute Aortic Dissection

Wang

Chen

et al. 2020

Preprint

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Objective: The study objective was to investigate the incidence and risk factors of continuous renal replacement treatment (CRRT) in patients undergoing emergency surgery for type A acute aortic dissection (TA-AAD) and evaluate the perioperative and long-term outcomes. Methods: From January 2014 to December 2018, 712 consecutive patients were enrolled in the study. These patients were divided into two groups according to whether or not needed severe postoperative acute kidney injury (AKI) requiring CRRT: the CRRT group vs the control group. Univariate analysis and binary logistic regression analysis were used to analyze the risk factors of CRRT. Significant variables by univariate analysis were included in binary logistic regression analysis. To avoid the selection bias and confounders, baseline characteristics were matched for propensity scores. One-to-one pair matching was performed using nearest neighbor matching without replacement within 0.02 standard deviations of the logit of the propensity score as caliper width. Kaplan-Meier curves were generated to provide survival estimates at postoperative points in time. Differences between the 2 groups were determined by log-rank tests. Results: Before propensity score matching, univariate analysis showed that there significant differences in age, preoperative hypertension, pericardial effusion, preoperative serum creatinine (sCr), intraoperative need for combined coronary artery bypass grafting (CABG) or mitral valve or tricuspid valve surgery, cardiopulmonary bypass (CPB) time, extracorporeal circulation assistant time, aortic cross-clamp time, drainage volume 24 hours after surgery and ventilator time between two groups. All were higher in the CRRT group (p<0.05). These risk factors were included in binary logistic regression. It showed that preoperative sCr (OR=1.008, 95% CI:1.002-1.014, P=0.005) and CPB time (OR=1.022, 95% CI:1.003-1.042, P=0.026) were independent risk factors for CRRT patients undergoing surgery for TA-AAD. And there were significant differences regarding 30-day mortality (P<0.001) and long-term overall cumulative survival (P<0.001) with up to a 6-year follow-up. After propensity scoring, 29 pairs (58 patients) were successfully matched. Among these patients, the analysis showed that CPB time was still significantly longer in the CRRT group (P = 0.004), and the 30-day mortality rate was also higher in this group (44.8% vs 10.3%; P = 0.003).Conclusion: CRRT after TA-AAD is common and worsened short- and long- term mortality. The preoperative sCr and CPB time are independent risk factors for postoperative CRRT patients. Shorten the CPB time as much as possible is recommended to reduce the risk of CRRT after the operation.

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Risk factors for continuous renal replacement therapy after surgical repair of type A aortic dissection

Abstract: In this series of patients with TAAD, the time of CPB (minute), sCr level (µmol/L) and the amount of red blood cell transfused intraoperatively (unit) were risk factors for CRRT after TAR + FET.

Cited by 25 publications

References 35 publications

Assessment of levels of D‑dimer and interferon‑γ in pediatric patients with Mycoplasma pneumoniae pneumonia and its clinical implication

Assessment of levels of D‑dimer and interferon‑γ in pediatric patients with Mycoplasma pneumoniae pneumonia and its clinical implication

Surgical Outcomes of Stent-Related Type A Dissection Compared with Spontaneous Type A Dissection

Independent Risk Factors and The Long-term Outcomes for Postoperative Continuous Renal Replacement Treatment in Patients Who Underwent Emergency Surgery for Type A Acute Aortic Dissection

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