Risk Factors of Hyperbilirubinemia after Acute Type A Aortic Dissection
DOI:
https://doi.org/10.59958/hsf.7199Keywords:
acute type A aortic dissection, hyperbilirubinemia, risk factorsAbstract
Objective: To explore the risk factors of hyperbilirubinemia after acute type A aortic dissection (ATAAD). Methods: Retrospective analysis of the data of 150 patients with ATAAD surgery in the First Affiliated Hospital of Gannan Medical University from 2021 to 2023. There were 117 males and 33 females. They were divided into patients according to the highest postoperative plasma total bilirubin level. Two groups, 85 cases in the hyperbilirubinemia group (HB group) total bilirubin (TBIL) >51.3 µmol/L; 65 cases in the non-hyperbilirubinemia group (NHB group) (TBIL <51.3 µmol/L). Two independent samples t-test was used to compare the two groups of samples, binary logistic regression analyzed the risk factors leading to postoperative HB, and the receiver operating characteristic (ROC) curve analyzed the critical values of the risk factors. Result: The incidence of postoperative HB was 56.7%. The preoperative plasma TBIL had an odds ratio (OR) of 1.213 (95% confidence interval (CI): 1.044–1.410, p = 0.012). The operation time had an OR of 1.019 (95% CI: 1.008–1.030, p = 0.001). The cardiopulmonary bypass (CPB) time had an OR of 1.053 (95% CI: 1.019–1.087, p = 0.022). The aortic cross-clamp time had an OR of 1.030 (95% CI: 1.006–1.055, p = 0.015). ROC curve analysis revealed critical values for preoperative plasma TBIL, operation time, CPB time, and aortic cross-clamp time as 12.95 µmol/L, 387.5 min, 190.5 min, and 117.5 min, respectively. Conclusion: HB is a frequently observed complication after surgery in patients with ATAAD, and it is associated with a poor prognosis. Several risk factors contribute to the increased occurrence of HB, including preoperative serum TBIL levels, operation time, CPB time, and aortic cross-clamp time.
References
Benedetto U, Dimagli A, Kaura A, Sinha S, Mariscalco G, Krasopoulos G, et al. Determinants of outcomes following surgery for type A acute aortic dissection: the UK National Adult Cardiac Surgical Audit. European Heart Journal. 2021; 43: 44–52.
Zheng Z, Yang L, Zhang Z, Wang D, Zong J, Zhang L, et al. Early and late outcomes of non-total aortic arch replacement for repair of acute Stanford Type A aortic dissection. American Journal of Translational Research. 2021; 13: 7047–7052.
Jiang D, Huo Y, Liu Y, Wang Y, Zhou J, Sun X, et al. One minute of circulatory arrest for acute type A aortic dissection ——— a simple operation for acute type A aortic dissection (AAAD). Journal of Cardiothoracic Surgery. 2020; 15: 328.
Yang L, Li J, Wang G, Zhou H, Fang Z, Shi S, et al. Postoperative liver dysfunction after total arch replacement combined with frozen elephant trunk implantation: incidence, risk factors and outcomes. Interactive Cardiovascular and Thoracic Surgery. 2019; 29: 930–936.
Chen X, Bai M, Zhang W, Sun S, Chen X. The incidence, risk factors, and prognosis of postoperative hyperbilirubinemia after cardiac surgery: a systematic review and meta-analysis. Annals of Palliative Medicine. 2021; 10: 7247–7257.
Chen X, Bai M, Zhao L, Li Y, Yu Y, Zhang W, et al. Characteristics and outcomes of Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia: a retrospective cohort study. Journal of Cardiothoracic Surgery. 2020; 15: 195.
Sharma P, Ananthanarayanan C, Vaidhya N, Malhotra A, Shah K, Sharma R. Hyperbilirubinemia after cardiac surgery: An observational study. Asian Cardiovascular & Thoracic Annals. 2015; 23: 1039–1043.
Hosotsubo KK, Nishimura M, Nishimura S. Hyperbilirubinaemia after major thoracic surgery: comparison between open-heart surgery and oesophagectomy. Critical Care. 2000; 4: 180–187.
An Y, Xiao YB, Zhong QJ. Hyperbilirubinemia after extracorporeal circulation surgery: a recent and prospective study. World Journal of Gastroenterology. 2006; 12: 6722–6726.
Zhang K, Pan XD, Dong SB, Zheng J, Xu SD, Liu YM, et al. Cardiopulmonary bypass duration is an independent predictor of adverse outcome in surgical repair for acute type A aortic dissection. The Journal of International Medical Research. 2020; 48: 300060520968450.
Gao Y, Li D, Dong H, Guo Y, Peng Y, Liu Y, et al. Risk factors analysis of hyperbilirubinemia after off-pump coronary artery bypass grafting: a retrospective observational study. Journal of Cardiothoracic Surgery. 2021; 16: 294.
Wang Z, Xu J, Cheng X, Zhang L, Wang D, Pan J. Hyperbilirubinemia after surgical repair for acute type a aortic dissection: A propensity score-matched analysis. Frontiers in Physiology. 2022; 13: 1009007.
Pino CJ, Lou L, Smith PL, Ding F, Pagani FD, Buffington DA, et al. A selective cytopheretic inhibitory device for use during cardiopulmonary bypass surgery. Perfusion. 2012; 27: 311–319.
Wang Z, Ge M, Chen C, Lu L, Zhang L, Wang D. Hepatic dysfunction in patients who received acute DeBakey type I aortic dissection repair surgery: incidence, risk factors, and long-term outcomes. Journal of Cardiothoracic Surgery. 2021; 16: 296.
Chintanaboina J, Haner MS, Sethi A, Patel N, Tanyous W, Lalos A, et al. Serum bilirubin as a prognostic marker in patients with acute decompensated heart failure. The Korean Journal of Internal Medicine. 2013; 28: 300–305.
Barateiro A, Domingues HS, Fernandes A, Relvas JB, Brites D. Rat cerebellar slice cultures exposed to bilirubin evidence reactive gliosis, excitotoxicity and impaired myelinogenesis that is prevented by AMPA and TNF-α inhibitors. Molecular Neurobiology. 2014; 49: 424–439.
Cui J, Zhao H, Yi B, Zeng J, Lu K, Ma D. Dexmedetomidine Attenuates Bilirubin-Induced Lung Alveolar Epithelial Cell Death In Vitro and In Vivo. Critical Care Medicine. 2015; 43: e356–e368.
Yuan L, Liao PP, Song HC, Zhou JH, Chu HC, Lyu L. Hyperbilirubinemia Induces Pro-Apoptotic Effects and Aggravates Renal Ischemia Reperfusion Injury. Nephron. 2019; 142: 40–50.
