Abstract
ObjectivesThe relationship between inflammatory cytokines and postoperative delirium (POD) remains to be further investigated, especially in patients undergoing acute type A aortic dissection (AAD). Interleukin-6 (IL-6) is involved in the inflammatory process and has recently been identified as a biomarker of cerebral dysfunction. We explored the hypothesis that IL-6 was one of the critical causes of POD after surgical repair of AAD.MethodsPlasma IL-6 was measured using electrochemiluminescence technology in patients preoperatively and 24 h, 48 h, and 72 h after surgical repair of acute type A aortic dissection. After the first three postoperative days, delirium was evaluated twice daily using the Confusion Assessment Method. ROC curves were used to evaluate the ability of IL-6 measurements to distinguish POD.ResultsThe incidence of POD was 14.03% (31 of 221 patients). The patients in the POD group were significantly older than the patients in the non-POD group (56.48 ± 11.68 years vs 52.22 ± 10.50 years, P = 0.040). Plasma IL-6 concentrations were significantly higher in the POD group than in the non-POD group at three time points: preoperatively, after 24 h, and after 48 h. The AUC values corresponding to IL-6 preoperatively and 24 h after surgery were 0.73 and 0.72, respectively.ConclusionsCerebral dysfunction after the surgical repair of AAD shows elevated stress levels and inflammatory responses. Plasma IL-6 is a potential biomarker to predict the onset of POD in acute type A aortic dissection patients following surgical repair.
Highlights
Acute type A aortic dissection (AAD) usually requires urgent surgical treatment to prevent death from aortic rupture
Materials and methods The present study was approved by the Fujian Medical University Union Hospital Ethics Committee, and Patients This study is a retrospective analysis of 260 consecutive patients admitted to our cardiac surgery center from March 2018 to January 2020 for open surgical repair combined with triple-branched stent graft implantation for repair of AAD
The excluded patients were as follows: 5 patients with prior neurological or psychiatric diseases, such as dementia, stroke, schizophrenia and depression; 3 patients with liver cirrhosis and uremia; 10 patients with preoperative stroke or brain malperfusion, and patients with preoperative shock or hemodynamic instanility due to cardiac tamponade; 8 patients with liver enzymes greater than four times the baseline; 5 patients who were comatose after the surgery or who died within 24 h after the surgery; 3 patients receiving extracorporeal membrane oxygenation therapy; and 5 patients who did not agree to participate in this clinical study
Summary
Acute type A aortic dissection (AAD) usually requires urgent surgical treatment to prevent death from aortic rupture. Aortic dissection itself may involve the blood supply of the nervous system, which may result in insufficient perfusion of the nervous system [1]. Postoperative delirium (POD) is a common complication after surgeries involving between 12 and 37% of patients undergoing aortic dissection surgery with serious effects on prognosis [2]. POD has been associated with several poor outcomes, including longer mechanical ventilation time, prolonged hospital stay, increased risk of death and greater risk of future dementia [3, 4]. It has been reported that delirium survivors are more likely to experience long-term cognitive impairment [5]
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