Characteristics and outcomes of Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia: a retrospective cohort study

Xiaolan Chen,Ming Bai,Xiangmei Chen,Yan Yu,Wei Zhang,Shiren Sun,Yangping Li,Lijuan Zhao,Feng Ma

doi:10.1186/s13019-020-01243-7

Abstract

BackgroundHyperbilirubinemia is one of the common complications after cardiac surgery and is associated with increased mortality. However, to the best of our knowledge, the reports on clinical significance of postoperative severe hyperbilirubinemia in Stanford type A aortic dissection (AAD) patients were limited.MethodsPatients who underwent surgical treatment for AAD in our center between January 2015 and December 2018 were retrospectively screened. In-hospital mortality, long-term mortality, acute kidney injury (AKI), and the requirement of continuous renal replacement therapy (CRRT) were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of these endpoints.ResultsAfter screening, 271 patients were included in our present study. Of the included patients, 222 (81.9%) experienced postoperative AKI, and 50 (18.5%) received CRRT. The in-hospital mortality was 30.3%. The 1-year, 2-year, and 3-year cumulative mortality were 32.9, 33.9, and 35.3%, respectively. Multivariate Logistic regression analysis indicated that age (P < 0.033), AKI stage 3 (P < 0.001), the amount of blood transfusion after surgery (P = 0.019), mean arterial pressure (MAP) in the first postoperative day (P = 0.012), the use of extracorporeal membrane oxygenation (ECMO) (P = 0.02), and the peak total bilirubin (TB) concentration (P = 0.023) were independent risk factors of in-hospital mortality. The optimal cut-off value of peak TB on predicting in-hospital mortality was 121.2 μmol/L. Patients with post-operation TB ≥ 121 μmol/L was associated with worse long-term survival as well.ConclusionsSevere post-operation hyperbilirubinemia is a common clinical situation in patients had AAD repair. In AAD patients with severe post-operation hyperbilirubinemia, older age, lower MAP, increased blood transfusion, stage 3 AKI, the use of ECMO, and the increased peak TB lead to increase in-hospital mortality.

Highlights

Aortic dissection (AD) is an acute life-threatening condition with a prevalence of about 3/100,000 per year
The International Registry of AD revealed that 67% of AD patients presented with Stanford type A aortic dissection (AAD), which was characterized as the involvement of the ascending aorta
For patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), recent study suggested that severe hyperbilirubinemia (5 times the normal upper limit) instead of mild bilirubin significantly increased patient mortality and a maximum bilirubin of 25.5 mg/dl was associated with 99% mortality [14]

Summary

Introduction

Aortic dissection (AD) is an acute life-threatening condition with a prevalence of about 3/100,000 per year. Hyperbilirubinemia was reported increased major adverse events and in-hospital and 30-day mortality for patients with cardiac surgery including aortic dissection surgery [9, 10]. The mortality of patients with severe post-operation hyperbilirubinemia remained significant divergence. Some of these patients recovered within weeks, others progressed to MODS and resulted in short-term death. The reports on the characteristics and outcomes of AAD surgery patients with severe post-operation hyperbilirubinemia are limited. To the best of our knowledge, the reports on clinical significance of postoperative severe hyperbilirubinemia in Stanford type A aortic dissection (AAD) patients were limited

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