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The risk factors and outcomes of preoperative hepatic dysfunction in patients who receive surgical repair for acute type A aortic dissection

BACKGROUND: Hepatic dysfunction (HD) is a common complication that can occur after surgical repair of acute type A aortic dissection (ATAAD) and is associated with poor prognosis. However, the incidence of early preoperative HD and the associated risk factors in patients with ATAAD have not been ful...

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Autores principales: Wang, Zhigang, Chen, Tao, Ge, Min, Chen, Cheng, Lu, Lichong, Zhang, Lifang, Wang, Dongjin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575816/
https://www.ncbi.nlm.nih.gov/pubmed/34795914
http://dx.doi.org/10.21037/jtd-21-1051
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author Wang, Zhigang
Chen, Tao
Ge, Min
Chen, Cheng
Lu, Lichong
Zhang, Lifang
Wang, Dongjin
author_facet Wang, Zhigang
Chen, Tao
Ge, Min
Chen, Cheng
Lu, Lichong
Zhang, Lifang
Wang, Dongjin
author_sort Wang, Zhigang
collection PubMed
description BACKGROUND: Hepatic dysfunction (HD) is a common complication that can occur after surgical repair of acute type A aortic dissection (ATAAD) and is associated with poor prognosis. However, the incidence of early preoperative HD and the associated risk factors in patients with ATAAD have not been fully elucidated. METHODS: A total of 984 ATAAD patients who received surgical repair within 48 hours of symptom onset at our department from January 2014 to December 2019 were retrospectively analyzed. Patients were divided into the non-HD group and the HD groups according to the Model of End-Stage Liver Disease (MELD) score before surgery. The clinical parameters and clinical outcomes of the 2 groups were collected and compared. RESULTS: Preoperative HD was detected in 268 patients (27.2%). The incidence of in-hospital complications, including the need for dialysis (34.0% vs. 9.2%; P<0.001), was significantly higher in patients with HD compared to patients without HD (69.8% vs. 51.0%; P<0.001). Patients with HD had a higher 30-day mortality rate compared to patients without HD (20.1% vs. 8.4%; P<0.001). Multivariate analysis demonstrated that preoperative cardiac tamponade, preoperative serum creatinine levels, and serum troponin T levels upon admission were independent predictors for preoperative HD in patients with ATAAD. Interestingly, even though preoperative HD was associated with an increased 30-day mortality rate, it did not significantly affect the long-term mortality rate (log-rank P=0.259). CONCLUSIONS: Early HD before surgery was commonly observed in patients with ATAAD and was associated with increased in-hospital complications after surgery, but did not significantly affect long-term survival.
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spelling pubmed-85758162021-11-17 The risk factors and outcomes of preoperative hepatic dysfunction in patients who receive surgical repair for acute type A aortic dissection Wang, Zhigang Chen, Tao Ge, Min Chen, Cheng Lu, Lichong Zhang, Lifang Wang, Dongjin J Thorac Dis Original Article BACKGROUND: Hepatic dysfunction (HD) is a common complication that can occur after surgical repair of acute type A aortic dissection (ATAAD) and is associated with poor prognosis. However, the incidence of early preoperative HD and the associated risk factors in patients with ATAAD have not been fully elucidated. METHODS: A total of 984 ATAAD patients who received surgical repair within 48 hours of symptom onset at our department from January 2014 to December 2019 were retrospectively analyzed. Patients were divided into the non-HD group and the HD groups according to the Model of End-Stage Liver Disease (MELD) score before surgery. The clinical parameters and clinical outcomes of the 2 groups were collected and compared. RESULTS: Preoperative HD was detected in 268 patients (27.2%). The incidence of in-hospital complications, including the need for dialysis (34.0% vs. 9.2%; P<0.001), was significantly higher in patients with HD compared to patients without HD (69.8% vs. 51.0%; P<0.001). Patients with HD had a higher 30-day mortality rate compared to patients without HD (20.1% vs. 8.4%; P<0.001). Multivariate analysis demonstrated that preoperative cardiac tamponade, preoperative serum creatinine levels, and serum troponin T levels upon admission were independent predictors for preoperative HD in patients with ATAAD. Interestingly, even though preoperative HD was associated with an increased 30-day mortality rate, it did not significantly affect the long-term mortality rate (log-rank P=0.259). CONCLUSIONS: Early HD before surgery was commonly observed in patients with ATAAD and was associated with increased in-hospital complications after surgery, but did not significantly affect long-term survival. AME Publishing Company 2021-10 /pmc/articles/PMC8575816/ /pubmed/34795914 http://dx.doi.org/10.21037/jtd-21-1051 Text en 2021 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Wang, Zhigang
Chen, Tao
Ge, Min
Chen, Cheng
Lu, Lichong
Zhang, Lifang
Wang, Dongjin
The risk factors and outcomes of preoperative hepatic dysfunction in patients who receive surgical repair for acute type A aortic dissection
title The risk factors and outcomes of preoperative hepatic dysfunction in patients who receive surgical repair for acute type A aortic dissection
title_full The risk factors and outcomes of preoperative hepatic dysfunction in patients who receive surgical repair for acute type A aortic dissection
title_fullStr The risk factors and outcomes of preoperative hepatic dysfunction in patients who receive surgical repair for acute type A aortic dissection
title_full_unstemmed The risk factors and outcomes of preoperative hepatic dysfunction in patients who receive surgical repair for acute type A aortic dissection
title_short The risk factors and outcomes of preoperative hepatic dysfunction in patients who receive surgical repair for acute type A aortic dissection
title_sort risk factors and outcomes of preoperative hepatic dysfunction in patients who receive surgical repair for acute type a aortic dissection
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575816/
https://www.ncbi.nlm.nih.gov/pubmed/34795914
http://dx.doi.org/10.21037/jtd-21-1051
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