Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar 19;19(1):138.
doi: 10.1186/s13019-024-02637-7.

Postoperative hyper-inflammation as a predictor of poor outcomes in patients with acute type A aortic dissection (ATAAD) undergoing surgical repair

Yuan-Xi Luo #  1 , Yusanjan Matniyaz #  2   3 , Yu-Xian Tang #  4 , Yun-Xing Xue  2 , Yi Jiang  1 , Ke Pan  5 , Zhi-Kang Lv  2 , Zhi-Wei Fan  4 , Kuo Wang  5 , Hai-Tao Zhang  1 , He Zhang  1 , Wen-Zhe Wang  2 , Tuo Pan  6   7 , Dong-Jin Wang  8   9   10   11 , Fu-Dong Fan  12
Affiliations

Postoperative hyper-inflammation as a predictor of poor outcomes in patients with acute type A aortic dissection (ATAAD) undergoing surgical repair

Yuan-Xi Luo et al. J Cardiothorac Surg. .

Abstract

Background: Postoperative hyper-inflammation is a frequent event in patients with acute Stanford type A aortic dissection (ATAAD) after surgical repair. This study's objective was to determine which inflammatory biomarkers could be used to make a better formula for identifying postoperative hyper-inflammation, and which risk factors were associated with hyper-inflammation.

Methods: A total of 405 patients were enrolled in this study from October 1, 2020 to April 1, 2023. Of these patients, 124 exhibited poor outcomes. In order to investigate the optimal cut-off values for poor outcomes, logistic and receiver operating characteristic analyses were performed on the following parameters on the first postoperative day: procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), and systemic immune-inflammation index (SII). These cut-off points were used to separate the patients into hyper-inflammatory (n = 52) and control (n = 353) groups. Finally, the logistic were used to find the risk factors of hyper-inflammatory.

Results: PCT, CRP, IL-6, and SII were independent risk factors of poor outcomes in the multivariate logistic model. Cut-off points of these biomarkers were 2.18 ng/ml, 49.76 mg/L, 301.88 pg/ml, 2509.96 × 109/L respectively. These points were used to define postoperative hyper-inflammation (OR 2.97, 95% CI 1.35-6.53, P < 0.01). Cardiopulmonary bypass (CPB) > 180 min, and deep hypothermia circulatory arrest (DHCA) > 40 min were the independent risk factors for hyper-inflammation.

Conclusions: PCT > 2.18, CRP > 49.76, IL-6 > 301.88, and SII < 2509.96 could be used to define postoperative hyper-inflammation which increased mortality and morbidity in patients after ATAAD surgery. Based on these findings, we found that CPB > 180 min and DHCA > 40 min were separate risk factors for postoperative hyper-inflammation.

Keywords: Acute Stanford type A aortic dissection; Cardiopulmonary bypass; Deep hypothermia circulatory arrest; Hyper-inflammation; Morbidity; Mortality.

PubMed Disclaimer

Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Univariable analysis for postoperative hyper-inflammation in patients with AAAD
Fig. 2
Fig. 2
Receiver operating characteristic curve (ROC) analyses with the area under the curve, sensitivity and specificity of CPB, ACC, DHCA in predicting postoperative hyper-inflammation
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Evangelista A, Isselbacher EM, Bossone E, Gleason TG, Eusanio MD, Sechtem U, Ehrlich MP, Trimarchi S, Braverman AC, Myrmel T, et al. Insights from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research. Circulation. 2018;137(17):1846–1860. doi: 10.1161/CIRCULATIONAHA.117.031264. - DOI - PubMed
    1. Li M, Xu S, Yan Y, Wang H, Zheng J, Li Y, Zhang Y, Hao J, Deng C, Zheng X, et al. Association of biomarkers related to preoperative inflammatory and coagulation with postoperative in-hospital deaths in patients with type A acute aortic dissection. Sci Rep. 2021;11(1):18775. doi: 10.1038/s41598-021-98298-w. - DOI - PMC - PubMed
    1. Erdolu B, As AK. C-reactive protein and neutrophil to lymphocyte ratio values in predicting inhospital death in patients with stanford type A acute aortic dissection. Heart Surg Forum. 2020;23(4):E488–E492. doi: 10.1532/hsf.3055. - DOI - PubMed
    1. Ma M, Shi J, Feng X, Wang J, Liu L, Wei X. The elevated admission white blood cell count relates to adverse surgical outcome of acute Stanford type a aortic dissection. J Cardiothorac Surg. 2020;15(1):48. doi: 10.1186/s13019-020-1078-5. - DOI - PMC - PubMed
    1. Chen Z-R, Huang B, Lu H-S, Zhao Z-H, Hui R-T, Yang Y-M, Fan X-H. Admission white blood cell count predicts short-term clinical outcomes in patients with uncomplicated Stanford type B acute aortic dissection. J Geriatr Cardiol. 2017;14(1):49–56. - PMC - PubMed