Abstract
Background: Although great progress has been made in surgery and perioperative care, stroke is still a fatal complication of acute type A aortic dissection (ATAAD). Serum biomarkers may help assess brain damage and predict patient's prognosis.Methods: From March, 2019 to January, 2020, a total of 88 patients underwent surgical treatment at the Department of Cardiovascular Surgery of Beijing Anzhen Hospital, China, and were enrolled in this study. Patients were divided into two groups according to whether they had suffered a stroke after the operation. Blood samples were collected at 8 time points within 3 days after surgery to determine the level of S100β, neuron-specific enolase (NSE) and neurofilament light chain protein (NFL). Receiver operating characteristic curves (ROC) were established to explore the biomarker predictive value in stroke. The area under the curve (AUC) was used to quantify the ROC curve.Results: The patient average age was 48.1 ± 11.0 years old and 70 (79.6%) patients were male. Fifteen (17.0%) patients suffered stroke after surgery. The NFL levels of patients in the stroke group at 12 and 24 h after surgery were significantly higher than those in the non-stroke group (all P < 0.001). However, the NSE and S100β levels did not differ significantly at any time point between the two groups. The predictive value of NFL was the highest at 12 and 24 h after surgery, and the AUC was 0.834 (95% CI, 0.723–0.951, P < 0.001) and 0.748 (95% CI, 0.603–0.894, P = 0.004), respectively. Its sensitivity and specificity at 12 h were 86.7 and 71.6%, respectively. The NFL cutoff value for the diagnosis of stroke at 12 h after surgery was 16.042 ng/ml.Conclusions: This study suggests that NFL is an early and sensitive serum marker for predicting post-operative neurological prognosis of ATAAD patients. Further studies, including large-scale prospective clinical trials, are necessary to test whether the NFL can be used as a biomarker for clinical decision-making.
Highlights
Acute type A aortic dissection (ATAAD) is a challenging condition that requires complex and life-saving cardiovascular surgery
Serum neuron-specific enolase (NSE) and S100β protein were considered promising candidate marker proteins for predicting the neurological status of patients after cardiac surgery [2,3,4], studies on these two markers yielded conflicting results [5, 6]. These two markers are expressed in neurons and in other; NSE is expressed in red blood cells and platelets, and S100β is expressed in fat and other tissues or organs [7,8,9]
Patients who met the inclusion criteria were admitted to the theater, blood samples were collected to determine the level of biomarkers at 8 time points: 5 min after induction of anesthesia (T0), at the beginning of selective cerebral perfusion (T1), at the time weaned from cardiopulmonary bypass (CPB) (T2), 6 h after operation (T3), 12 h after operation (T4), 24 h after operation (T5), 48 h after operation (T6), and 72 h after operation (T7)
Summary
Acute type A aortic dissection (ATAAD) is a challenging condition that requires complex and life-saving cardiovascular surgery. Serum neuron-specific enolase (NSE) and S100β protein were considered promising candidate marker proteins for predicting the neurological status of patients after cardiac surgery [2,3,4], studies on these two markers yielded conflicting results [5, 6]. These two markers are expressed in neurons and in other; NSE is expressed in red blood cells and platelets, and S100β is expressed in fat and other tissues or organs [7,8,9]. Serum biomarkers may help assess brain damage and predict patient’s prognosis
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