Introduction
Patients and method
Study design and patients selection
Surgical procedure
Data collection
Outcomes and definition
Statistical analysis
Result
Patient characteristics
Variables | Value |
---|---|
Preoperative | |
Age, mean ± SD (years) | 49.1 ± 11.0 |
Male, n (%) | 223 (82.3%) |
Co-morbidity | |
Hypertension, n (%) | 158 (58.3%) |
Diabetes, n (%) | 3 (1.1%) |
Cerebrovascular disease, n (%) | 16 (5.9%) |
Previous cardiac surgery, n (%) | 8 (2.9%) |
APACHEII score, mean ± SD | 9.2 ± 3.2 |
MELD score, mean ± SD | 9.2 ± 4.1 |
SOFA score, mean ± SD | 2.1 ± 1.5 |
MAP, mean ± SD (mm/Hg) | 90.5 ± 12.9 (70–105) |
TB, mean ± SD (μmol/l) | ↑25.0 ± 15.0 (3.4–20.5) |
CB, mean ± SD (μmol/l) | ↑7.8 ± 8.1 (0.0–6.8) |
WBC, mean ± SD (109/l) | ↑11.7 ± 5.0 (3.5–9.5) |
Hb, mean ± SD (g/l) | 136.1 ± 19.9 (130–175) |
PLT, mean ± SD (109 /l) | ↑157.2 ± 68.5 (125–350) |
SCr, mean ± SD (μmol/l) | ↑111.1 ± 38.3 (57–111) |
PT, mean ± SD (s) | 12.0 ± 2.2 (9.8–12.1) |
Intraoperative | |
Type of operation | |
Ascending aorta, n (%) | 227 (83.8%) |
Aortic valve | 191 (70.7%) |
Aortic arch, n (%) | 233 (86%) |
Coronary artery, n (%) | 46 (17%) |
Operation duration, mean ± SD (h) | 6.8 ± 1.6 |
CPB time, mean ± SD (min) | 226.5 ± 60.9 |
ACC time, mean ± SD (min) | 102.2 ± 28.0 |
Arrest time, mean ± SD (min) | 25.1 ± 14.4 |
The amount of blood transfusion (U) | 18.8 ± 10.6 |
Postoperative | |
APACHE II score | 16.9 ± 2.5 |
SOFA score | 12.1 ± 2.6 |
Meld score | 18.6 ± 4.4 |
AST, mean ± SD (U /L) | ↑347.6 ± 1387.2 (9–50) |
ALT, mean ± SD (U/L) | ↑164.4 ± 526.6 (9–50) |
TB, mean ± SD (μmol /l) | ↑189.1 ± 74.6 (3.4–20.5) |
CB, mean ± SD (μmol /l) | ↑110.7 ± 37.9 (0.0–6.8) |
WBC, mean ± SD (109/l) | ↑12.9 ± 4.8 (3.5–9.5) |
Hb, mean ± SD (g/l) | 112.9 ± 16.6 (130–175) |
PLT, mean ± SD (109 /l) | ↓99.8 ± 49.5 (125–350) |
SCr, mean ± SD (μmol/l) | ↑162.8 ± 71.8 (57–111) |
PT, mean ± SD (s) | 13.6 ± 2.9 (9.8–12.1) |
Peak TB level, mean ± SD (μmol/l) | 150.9 ± 93.0 |
Peak TB level > 171 μmol/l, n (%) | 55 (20.4%) |
Peak TB level > 340 μmol/l, n (%) | 12 (4.4%) |
Time to peak TB level, mean ± SD (d) | 3.8 ± 3.0 |
Time to peak TB level > 5 d, n (%) | 47 (17.4%) |
Postoperative AKI
Variables | Value |
---|---|
In-hospital mortality, n (%) | 82 (30.3%) |
Cause of death | |
Multiple organ failure, n (%) | 40 (48.8%) |
Heart failure, n (%) | 35 (42.7%) |
Hemorrhagic shock, n (%) | 2 (2.4%) |
Sepsis, n (%) | 5 (6.1%) |
Reoperation, n (%) | 17 (6.3%) |
AKI, n (%) | 222 (81.9%) |
Stage of AKI | |
Stage 1, n (%) | 102 (40.2%) |
Stage 2, n (%) | 34 (12.5%) |
Stage 3, n (%) | 84 (29.2%) |
Use of CRRT, n (%) | 50 (18.5%) |
Use of PE/BA, n (%) | 11 (14.1%) |
Use of IABP, n (%) | 1 (0.4%) |
Use of ECMO, n (%) | 7 (2.6%) |
Use of vasoactive agent, n (%) | 173 (63.8%) |
Mechanical ventilation time, mean ± SD (days) | 3.3 ± 5.7 |
The amount of blood transfusion, mean ± SD (U) | 34.8 ± 43.3 |
In hospital time, mean ± SD (days) | 19.8 ± 10.7 |
ICU stay time, mean ± SD (days) | 6.6 ± 6.3 |
Onset of severe hyperbilirubinemia, mean ± SD (days) | 2.8 ± 1.3 |
Characteristic | Univariate logistic regression | Multivariate logistic regression | ||
---|---|---|---|---|
OR (95%CI) | P value | OR (95%CI) | P value | |
Postoperative AKI | ||||
Age | 1.061 (1.032–1.092) | < 0.001 | 1.056 (1.026–1.088) | < 0.001 |
Hypertension (yes/no) | 2.766 (1.469–5.208) | 0.002 | ||
Preoperative | ||||
SCr | 1.030 (1.014–1.047) | < 0.001 | 1.026 (1.010–1.043) | 0.002 |
APACHE II score | 1.399 (1.213–1.615) | < 0.001 | ||
MELD score | 1.130 (1.035–1.233) | 0.007 | ||
Operation duration | 1.346 (1.089–1.633) | 0.006 | ||
CPB time | 1.008 (1.001–1.014) | 0.015 | 1.007 (1.000–1.013) | 0.042 |
Postoperative CRRT | ||||
Male (yes/no) | 4.006 (1.192–13.462) | 0.025 | ||
Preoperative | ||||
SCr | 1.011 (1.003–1.018) | 0.004 | 1.009 (1.002–1016) | 0.017 |
APACHE II score | 1.333 (1.033–1.244) | 0.008 | ||
MELD score | 1.083 (1.007–1.164) | 0.032 | ||
ACC time | 1.011 (1.000–1.022) | 0.049 |
Postoperative CRRT
In-hospital mortality
Characteristic | Univariate logistic regression | Multivariate logistic regression (model 1) | Multivariate logistic regression (model 2) | |||
---|---|---|---|---|---|---|
OR (95%CI) | P value | OR (95%CI) | P value | OR (95%CI) | P value | |
Age (year) | 1.035 (1.009–1.062) | 0.008 | 1.005 (1.004–1.099) | 0.033 | 1.046 (1.002–1.093) | 0.040 |
Male (yes/no) | 2.483 (1.106–5.575) | 0.027 | ||||
Preoperative | ||||||
SCr | 1.009 (1.002–1.016) | 0.008 | ||||
APACHE II score | 1.178 (1.082–1.282) | < 0.001 | ||||
Intraoperative | ||||||
CPB time | 1.007 (1.003–1.011) | 0.002 | ||||
ACC time | 1.012 (1.002–1.021) | 0.014 | ||||
Deep hypothermic circulatory arrest time | 0.997 (0.979–1.016) | 0.787 | ||||
Postoperative | ||||||
MAP | 0.948 (0.926–0.971) | < 0.001 | 0.955 (0.922–0.990) | 0.012 | 0.963 (0.930–0.977) | 0.031 |
Re-operation (yes/no) | 3.611 (1.324–9.852) | 0.012 | ||||
The total amount of blood transfusion | 1.046 (1.032–1.060) | < 0.001 | 1.018 (1.003–1.033) | 0.019 | 1.020 (1.005–1.034) | 0.007 |
Mechanical ventilation time | 1.533 (1.341–1.798) | < 0.001 | ||||
AKI (yes/no) | 28.350 (3.842–209.203) | 0.001 | ||||
Stage of AKI | < 0.001 | < 0.001 | < 0.001 | |||
Stage 1 | 5.859 (0.735–46.720) | 0.095 | 2.424 (0.267–21.990) | 0.431 | 2.218 (0.253–19.426) | 0.472 |
Stage 2 | 10.138 (1.162–88.457) | 0.036 | 4.560 (0.478–43.545) | 0.187 | 3.698 (0.385–35.548) | 0.257 |
Stage 3 | 165.053 (21.354–1275.729) | < 0.001 | 46.134 (5.436–391.525) | < 0.001 | 46.318 (5.666–378.663) | < 0.001 |
Use of CRRT (yes/no) | 23.756 (10.359–54.481) | 0.001 | ||||
Use of PE/BA (yes/no) | 11.527 (2.432–54.631) | 0.002 | ||||
Use of ECMO (yes/no) | 14.842 (1.757–125.357) | 0.013 | 20.795 (1.620–266.917) | 0.02 | 10.130 (0.900–113.958) | 0.061 |
Peak TB concentration | 1.009 (1.005–1.012) | < 0.001 | 1.017 (1.002–1.032) | 0.023 | ||
Peak TB ≥121 μmol/l, (yes/no) | 3.899 (2.220–6.847) | < 0.001 | 2.681 (1.119–6.425) | 0.027 | ||
Time to peak TB concentration | 1.441 (1.277–1.626) | < 0.001 | ||||
ICU stay time | 1.268 (1.172–1.371) | < 0.001 |
Long-term mortality
Characteristic | Univariate COX regression | Multivariate COX regression | ||
---|---|---|---|---|
OR (95%CI) | P value | OR (95%CI) | P value | |
Age | 1.023 (1.003–1.043) | 0.026 | ||
Preoperative | ||||
SCr | 1.006 (1.002–1.010) | < 0.001 | ||
APACHE II score | 1.122 (1.060–1.188) | < 0.001 | ||
MELD score | 1.052 (1.003–1.105) | 0.039 | ||
Intraoperative | ||||
Operation duration | 1.248 (1.098–1.414) | 0.001 | ||
CPB time | 1.005 (1.002–1.008) | 0.001 | ||
Postoperative | ||||
MAP | 0.971 (0.957–0.985) | < 0.001 | 0.979 (0.962–0.995) | 0.012 |
The total amount of blood transfusion | 1.009 (1.007–1.011) | < 0.001 | ||
Mechanical ventilation time | 1.035 (1.020–1.051) | < 0.001 | ||
AKI (yes/no) | 6.25 (2.295–17.024) | < 0.001 | ||
Stage of AKI | < 0.001 | < 0.001 | ||
Stage 1 | 1.404 (0.506–3.901) | 0.515 | 1.037 (0.365–2.946) | 0.946 |
Stage 2 | 2.772 (0.929–8.271) | 0.068 | 2.236 (0.774–6.990) | 0.133 |
Stage 3 | 15.071 (6.043–37.587) | < 0.001 | 12.604 (5.002–31.762) | < 0.001 |
Use of CRRT (yes/no) | 6.368 (4.174–9.709) | < 0.001 | ||
Use of PE/BA (yes/no) | 3.184 (1.596–6.351) | 0.001 | ||
Use of ECMO (yes/no) | 6.108 (2.638–14.139) | < 0.001 | 12.167 (4.588–32.264) | < 0.001 |
Onset of hyperbilirubinemia | 1.217 (1.044–1.418) | 0.012 | ||
Peak TB concentration | 1.004 (1.003–1.006) | < 0.001 | ||
Peak TB > 121 μmol/l (yes/no) | 2.595 (1.679–4.001) | < 0.001 | ||
Peak TB > 171 μmol/l (yes/no) | 2.292 (1.488–3.530) | < 0.001 | ||
Time to peak TB concentration | 1.156 (1.107–1.208) | < 0.001 | ||
ICU stay time | 1.037 (1.022–1.053) | < 0.001 |