Analysis of risk factors for perioperative hyperbilirubinemia in Stanford type A aortic dissection

Abstract

Objective To analyze the independent risk factors and complications for perioperative hyperbilirubinemia in Stanford type A aortic dissection undergoing operation and investigate the management strategy of perioperative hyperbilirubinemia. Methods Between January 2013 and January 2018 from the department of great vessel surgery of heart centre of, 290 cases of patients with Stanford type A aortic dissection undergoing operation were collected consecutively, male 210 cases, female 80 cases. The related data and perioperative peak hyperbilirubinemia were recorded. According to the perioperative peak hyperbilirubinemia, patients were divided into 2 groups: ≥51.3 μmol/L group and <51.3 μmol/L group. Univariate and logistic regression analysis were used to identify the independent risk factors. The perioperative complications were also recorded. Results Preoperative total bilirubin ≥17.1 μmol/L(OR=2.105, 95%CI: 1.153-3.125, P=0.016), cardiopulmonary bypass time >3.5 h(OR=1.103, 95%CI: 1.316-6.151, P=0.031), a large number of hemolysis(OR=1.503, 95%CI: 1.506-6.651, P=0.029), the input amount of 24 h allogeneic red blood cell >2 000 ml(OR=1.381, 95%CI: 0.956-2.552, P=0.036)were the independent risk factors for perioperative hyperbilirubinemia. The incidence rate of postoperative acute hepatic failure(2.5%vs.0, P=0.021) and artificial liver therapy(2.5%vs.0, P=0.021) in≥51.3 μmol/L group were significantly increased. The incidence rate of postoperative acute lung injury(37.5%vs. 25.2%, P=0.039) and acute kidney injury(38.7%vs.19.5%, P=0.035) in 51.3 μmol/L group were also significantly increased. The duration of mechanical ventilation[(4.1±1.6)days vs.(2.8±1.3)days, P<0.05]and ICU stay time[(5.1±2.3) days vs.(3.9±1.8)days, P=0.035] and hospitalization time[(19.3±3.1) days vs.(17.3±2.5)days, P=0.035]were significantly prolonged. Temporary nerve dysfunction(52.5%vs. 32.6%, P=0.002) and in-hospital mortality(17.5%vs.8.1%, P=0.037)were significantly increased. Conclusion Preoperative total bilirubin ≥17.1 μmol/L, cardiopulmonary bypass time >3.5 h, a large number of hemolysis, the input amount of 24 h allogeneic red blood cell >2 000 ml were the independent risk factors for perioperative hyperbilirubinemia in Stanford type A aortic dissection. The perioperative complications in≥51.3 μmol/L group were significantly increased. Therefore, more attention should be paid to the independent risk factors for perioperative hyperbilirubinemia in Stanford type A aortic dissection, hyperbilirubinemia and its clearance should be monitored more actively and dynamically, the cause should be found more precisely, the treatment be more comprehensive to achieve to control the level of bilirubinemia and improve the prognosis. Key words: Stanford type A aortic dissection; Cardiopulmonary bypass; Deep hypothermic circulatory arrest; Hyperbilirubinemia