The risk factors for and outcomes of preoperative hepatic dysfunction in patients who received surgical repair for acute DeBakey type I aortic dissection
10.3760/cma.j.cn112434-20210603-00187
- VernacularTitle:急性DeBakey Ⅰ型主动脉夹层术前发生肝功能不全的相关危险因素分析及其预后
- Author:
Zhigang WANG
1
;
Min GE
;
Tao CHEN
;
Cheng CHEN
;
Lichong LU
;
Dongjin WANG
Author Information
1. 南京大学医学院附属鼓楼医院心胸外科，南京 210008
- Keywords:
Hepatic dysfunction;
Aortic dissection;
Risk factors
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2022;38(4):230-234
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To identify the risk factors for and outcomes of preoperative hepatic dysfunction (HD) in patients who underwent surgery for the treatment of acute DeBakey type I aortic dissection (ADIAD).Methods:A retrospective study including 810 consecutive patients between January 2014 and December 2019 in Nanjing Drum Tower Hospital was performed with emergency surgical repair. All patients were divided into non-HD and HD groups according to the Model of End-Stage Liver Disease (MELD) score before surgery and their clinical parameters and clinical outcomes were collected and compared. To determine independent predictors of preoperative HD, multivariate logistic regression analyses were performed using variables with P<0.5 in the univariate analyses. Kaplan-Meier survival analyses were conducted to analyze the association between preoperative HD and postoperative long-term survival. Results:The mean age of the patients was (52.4±12.5) years. 215 patients (26.5%) were identified as the preoperative HD group. In univariate analysis, significant difference was found with respect to the postoperative complications (98.6% vs. 94.5%, P=0.011) and 30-day mortality (20.0% vs. 8.4%, P<0.001) between the two groups. Multivariate logistic analysis showed that elevated serum troponin T levels upon admission( OR=1.921, P<0.001) and preoperative cardiac tamponade ( OR=2.158, P=0.002) were independent risk factors for preoperative HD. The long-term mortality rate was not significantly affected by preoperative HD. Conclusion:Early HD before surgery was commonly observed in patients with ADIAD and was associated with increased postoperative complications and 30-Day mortality. Elevated serum troponin T levels upon admission and preoperative cardiac tamponade were identified as risk factors for preoperative HD.
