The Blood Sugar Level Can Predict the Preoperative Shock in Patients With Ruptured Abdominal Aortic Aneurysm Even When the Patient's Condition Looks Stable

Abstract

Introduction: This study aimed to identify the preoperative blood test data which can predict the preoperative shock in ruptured abdominal aortic aneurysm (rAAA). Methods: Total of 117 patients who underwent surgery including open repair and/or EVAR for rAAA between January 2007 and December 2018 were reviewed. The diagnosis of rAAA was made by computed tomography (CT) scan. Of these, 13 patients who underwent cardio pulmonary resuscitation at arrival, had been hospitalized for elective surgery for AAA, were complicated with chronic type B aortic dissection, and had been treated using the balloon occlusion at another hospital were excluded. In 104 patients (80% men, mean age 76 ± 10 years) with sufficient data, preoperative shock defined as a shock index (=heart rate/blood pressure) more than 1.5 or a maximum blood pressure less than 80 mmHg was observed in 43 patients (41%). Status of shock was categorized as follows; 1) “temporary shock before arrival” in 3 patients (7%) who had been treated by fluid resuscitation at community hospital and referred in stable condition, 2) “continuous shock” in 32 (74%) who arrived with shock that continued until aortic clamp, and 3) “shock after arrival” in 8 (19%) who arrived without shock but deteriorated into shock at emergency room in 6 and during CT scan in 2. To investigate the relation between shock and blood test data including blood sugar (BS), white blood cells, hemoglobin (Hb), platelets, C-reacting protein (CRP), creatinine, and fibrinogen degradation products in patients with rAAA, univariable and multivariable analyses were performed using the Logistic regression analysis. Results: The overall hospital mortality rate was 11% (11/104). BS (odds ratio [OR], 1.02; 95% confidence interval [CI]: 1.01-1.03; p=0.0001), CRP (OR, 0.56; 95% CI: 0.37-0.84; p=0.006), and Hb (OR, 0.63; 95% CI: 0.47-0.84; p=0.002) were identified as independent positive predictors of preoperative shock with multivariable analysis. The receiver operating characteristics curve (ROC) analysis for BS showed that area under the curve (AUC) for the predicted probabilities was 0.86 and at a cut-off value of 215 mg/dl, the sensitivity of the minimum BS level for predicting preoperative shock was 86% with a specificity of 79%. (Figure 1) The ROC curve for CRP showed the AUC of 0.74 and that for Hb presented the AUC of 0.69. BS level more than 215mg/dl were observed in 67% (2/3) patients with “temporary shock”, in 84% (27/32) with“continuous shock”, and in 100% (8/8) with“shock after arrival”. Conclusion: The BS level can be utilized as an independent predictor of preoperative shock in patients with rAAA. The patients having the preoperative BS level of 215mg/dl or more should be recognized as the patients to be treated emergently even when the patient's condition looks stable such as “temporary shock before arrival” or “shock after arrival”. Disclosure: Nothing to disclose