Plasma interleukin-6 is a potential predictive biomarker for postoperative delirium among acute type a aortic dissection patients treated with open surgical repair

Abstract Objectives The 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. Methods Plasma 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. Results The 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. Conclusions Cerebral 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.

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Plasma Interleukin-6 is a Potential Predictive Biomarker for Postoperative Delirium among Acute Type A Aortic Dissection Patients Treated with Open Surgical Repair

10.21203/rs.3.rs-145157/v1 ◽

2021 ◽

Author(s):

Xiao-Chai Lv ◽

Yong Lin ◽

Qing-song Wu ◽

Lei Wang ◽

Yan-ting Hou ◽

...

Keyword(s):

Aortic Dissection ◽

Interleukin 6 ◽

Postoperative Delirium ◽

Surgical Repair ◽

Inflammatory Responses ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Cerebral Dysfunction ◽

Potential Biomarker

Abstract Objectives. The 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.Methods. Plasma 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.Results. The 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.Conclusions. Cerebral 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.

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Results following surgical repair of acute type A aortic dissection (AAAD): A single centre experience

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269332 ◽

2011 ◽

Vol 59 (S 01) ◽

Author(s):

P Benedikt ◽

L Bartl ◽

P Hartl ◽

C Schwarz

Keyword(s):

Aortic Dissection ◽

Surgical Repair ◽

Type A ◽

Acute Type ◽

Single Centre ◽

Type A Aortic Dissection ◽

Single Centre Experience

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Trends and Risk Factors for Stroke and Mortality following Surgical Repair of acute Type A Aortic Dissection: A Single-Center Experience Over 15 Years

10.1055/s-0040-1705513 ◽

2020 ◽

Author(s):

F. Pollari ◽

S. Pfeiffer ◽

C. Eckrich ◽

J. Sirch ◽

T. Fischlein

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Surgical Repair ◽

Type A ◽

Acute Type ◽

Single Center ◽

Type A Aortic Dissection ◽

Single Center Experience

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Aggrecan: a new biomarker for acute type A aortic dissection

Scientific Reports ◽

10.1038/s41598-021-89653-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Karl C. König ◽

Harald Lahm ◽

Martina Dreßen ◽

Stefanie A. Doppler ◽

Stefan Eichhorn ◽

...

Keyword(s):

Aortic Dissection ◽

Troponin T ◽

Type A ◽

Aortic Aneurysms ◽

Aortic Tissue ◽

Acute Type ◽

Type A Aortic Dissection ◽

Potential Biomarker ◽

Aortic Pathology ◽

Creatine Kinase Mb

AbstractAcute type A aortic dissection (ATAAD) constitutes a life-threatening aortic pathology with significant morbidity and mortality. Without surgical intervention the usual mortality rate averages between 1 and 2% per hour. Thus, an early diagnosis of ATAAD is of pivotal importance to direct the affected patients to the appropriate treatment. Preceding tests to find an appropriate biomarker showed among others an increased aggrecan (ACAN) mRNA expression in aortic tissue of ATAAD patients. As a consequence, we investigated whether ACAN is a potential biomarker for diagnosing ATAAD. Mean ACAN protein concentration showed a significantly higher plasma concentration in ATAAD patients (38.59 ng/mL, n = 33) compared to plasma of patients with thoracic aortic aneurysms (4.45 ng/mL, n = 13), patients with myocardial infarction (11.77 ng/mL, n = 18) and healthy volunteers (8.05 ng/mL, n = 12). Cardiac enzymes like creatine kinase MB and cardiac troponin T showed no correlation with ACAN levels in ATAAD patients. Receiver-operator characteristics (ROC) curve analysis for ATAAD patients versus control subjects an optimum discrimination limit of ACAN plasma levels at 14.3 ng/mL with a corresponding sensitivity of 97% and specificity of 81%. According to our findings ACAN is a reliable potential biomarker in plasma samples to detect ATAAD with high sensitivity and specificity.

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Risk factors for hypoxemia following surgical repair of acute type A aortic dissection

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivw272 ◽

2016 ◽

pp. ivw272

Author(s):

Nan Liu ◽

Wei Zhang ◽

Weiguo Ma ◽

Wei Shang ◽

Jun Zheng ◽

...

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Surgical Repair ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Effects of Sex on Early Outcome following Repair of Acute Type A Aortic Dissection: Results from The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

Aorta ◽

10.1055/s-0039-1687900 ◽

2019 ◽

Vol 07 (01) ◽

pp. 007-014

Author(s):

Raphaelle A. Chemtob ◽

Vibeke Hjortdal ◽

Anders Ahlsson ◽

Jarmo Gunn ◽

Ari Mennander ◽

...

Keyword(s):

Aortic Dissection ◽

Surgical Repair ◽

Multivariable Analysis ◽

Operation Time ◽

Postoperative Outcome ◽

Type A ◽

Operative Management ◽

Chronic Obstructive ◽

Acute Type ◽

Type A Aortic Dissection

Background Female sex is known to have increased perioperative mortality in cardiac surgery. Studies reporting effects of sex on outcome following surgical repair for acute Type A aortic dissection (ATAAD) have been limited by small cohorts of heterogeneous patient populations and have shown diverging results. This study aimed to compare perioperative characteristics, operative management, and postoperative outcome between sexes in a large and well-defined cohort of patients operated for ATAAD. Methods The Nordic Consortium for Acute Type A Aortic Dissection study included patients with surgical repair of ATAAD at eight Nordic centers between January 2005 and December 2014. Independent predictors of 30-day mortality were identified using multivariable logistic regression. Results Females represented 373 (32%) out of 1,154 patients and were significantly older (65 ± 11 vs. 60 ± 12 years, p < 0.001), had lower body mass index (25.8 ± 5.4 vs. 27.2 ± 4.3 kg/m2, p < 0.001), and had more often a history of hypertension (59% vs. 48%, p = 0.001) and chronic obstructive pulmonary disease (8% vs. 4%, p = 0.033) compared with males. More females presented with DeBakey class II as compared with males with dissection of the ascending aorta alone (33.4% vs. 23.1%, p = 0.003). Hypothermic cardiac arrest time (28 ± 16 vs. 31 ± 19 minutes, p = 0.026) and operation time (345 ± 133 vs. 374 ± 135 minutes, p < 0.001) were shorter among females. There was no difference between the sexes in unadjusted intraoperative death (9.1% vs. 6.7%, p = 0.17) or 30-day mortality (17.7% vs. 17.4%, p = 0.99). In a multivariable analysis including perioperative factors influencing mortality, no difference was found between females and males in 30-day mortality (odds ratio: 0.92, 95% confidence interval: 0.62–1.38, p = 0.69). Conclusions This study found no association between sex and early mortality following surgery for ATAAD, despite females being older and having more comorbidities, yet also presenting with a less widespread dissection than males.

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