scholarly journals Construction and Application of a Model for Predicting the Risk of Delirium in Postoperative Patients With Type a Aortic Dissection

2021 ◽  
Vol 8 ◽  
Author(s):  
Junfeng He ◽  
Qing Ling ◽  
Yuhong Chen
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Output ◽  
Aortic Dissection ◽  
Prediction Model ◽  
Cardiovascular Surgery ◽  
Kidney Injury ◽  
Type A ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Type A Aortic Dissection

Background: Postoperative delirium (POD), an alteration in a patient's consciousness pattern, can affect the treatment and prognosis of a disease.Objective: To construct a prediction model for delirium in patients with type A aortic dissection after surgery and to validate its effectiveness.Methods: A retrospective cohort design was used to study 438 patients undergoing surgical treatment for type A aortic dissection from April 2019 to June 2020 in tertiary care hospitals. POD (n = 78) and non-delirium groups (n = 360) were compared and analyzed for each index in the perioperative period. A prediction model was established using multifactorial logistic regression, and 30 patients' perioperative data were collected for model validation.Results: Eight predictors were included in this study: smoking, diabetes, previous cardiovascular surgery, ejection fraction (EF), time to aortic block, acute kidney injury, low cardiac output syndrome, and pulmonary complications. The area under the receiver operating characteristic (ROC) curve of the constructed prediction model was 0.98 ± 0.005, and the Youden index was 0.91. The validation results showed 97% sensitivity, 100% specificity, and 93% accuracy. The expression of the model was Z = Smoking assignment* – 2.807 – 6.009*Diabetes assignment – 2.994*Previous cardiovascular surgery assignment – 0.129*Ejection fraction assignment + 0.071*Brain perfusion time assignment – 2.583*Acute kidney injury assignment – 2.916*Low cardiac output syndrome assignment – 3.461*Pulmonary related complications assignment + 20.576.Conclusion: The construction of an effective prediction model for the risk of delirium in patients after type A aortic stratification can help identify patients at high risk of POD early. It also provides a reference for healthcare professionals in the prevention and care of these patients.

scholarly journals Can Renal Resistive Index Predict Acute Kidney Injury After Acute Type A Aortic Dissection Repair?

2017 ◽  
Vol 104 (5) ◽  
pp. 1583-1589 ◽  
Author(s):  
Hai-Bo Wu ◽  
Huai Qin ◽  
Wei-Guo Ma ◽  
Hong-Lei Zhao ◽  
Jun Zheng ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Aortic Dissection ◽  
Resistive Index ◽  
Kidney Injury ◽  
Type A ◽  
Renal Resistive Index ◽  
Acute Type ◽  
Type A Aortic Dissection

Acute Kidney Injury Following Acute Repair of Type A Aortic Dissection

2020 ◽  
Author(s):  
Dadi Helgason ◽  
Solveig Helgadottir ◽  
Anders Ahlsson ◽  
Jarmo Gunn ◽  
Vibeke Hjortdal ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Aortic Dissection ◽  
Kidney Injury ◽  
Type A ◽  
Type A Aortic Dissection

Levosimendan Reduces Mortality and Low Cardiac Output Syndrome in Cardiac Surgery

2019 ◽  
Vol 68 (05) ◽  
pp. 401-409
Author(s):  
Antje Christin Deppe ◽  
Thorsten C. W. Wahlers ◽  
Carolyn Weber ◽  
Matthias Esser ◽  
Kaveh Eghbalzadeh ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Output ◽  
Cardiac Surgery ◽  
Literature Search ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Controlled Trials ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Randomized Controlled

Abstract Background There has been conflicting evidence concerning the effect of levosimendan on clinical outcomes in patients undergoing cardiac surgery. Therefore, we performed a systematic review and conducted this meta-analysis to provide evidence for/against the administration of levosimendan in cardiac surgery patients. Methods We performed a meta-analysis from literature search in PubMed, EMBASE, and Cochrane Library. Only randomized controlled trials comparing the administration of levosimendan in cardiac surgery patients with a control group (other inotrope, standard therapy/placebo, or an intra-aortic balloon pump) were included. In addition, at least one clinical outcome had to be mentioned: mortality, myocardial infarction, low cardiac output syndrome (LCOS), acute kidney injury, renal replacement therapy, atrial fibrillation, prolonged inotropic support, length of intensive care unit, and hospital stay. The pooled treatment effects (odds ratio [OR], 95% confidence intervals [CI]) were assessed using a fixed or random effects model. Results The literature search retrieved 27 randomized, controlled trials involving a total of 3,198 patients. Levosimendan led to a significant reduction in mortality (OR: 0.67; 95% CI: 0.49–0.91; p = 0.0087). Furthermore, the incidence of LCOS (OR: 0.56, 95% CI: 0.42–0.75; p < 0.0001), acute kidney injury (OR: 0.63; 95% CI: 0.46–0.86; p = 0.0039), and renal replacement therapy (OR: 0.70; 95% CI: 0.50–0.98; p = 0.0332) was significantly decreased in the levosimendan group. Conclusion Our meta-analysis suggests beneficial effects for the prophylactic use of levosimendan in patients with severely impaired left ventricular function undergoing cardiac surgery. The administration of levosimendan was associated with a reduced mortality, less LCOS, and restored adequate organ perfusion reflected in less acute kidney injury.

scholarly journals Preoperative renal malperfusion is an independent predictor for acute kidney injury and operative death but not associated with late mortality after surgery for acute type A aortic dissection

2020 ◽  
Vol 58 (2) ◽  
pp. 302-308
Author(s):  
Kosaku Nishigawa ◽  
Toshihiro Fukui ◽  
Kohei Uemura ◽  
Shuichiro Takanashi ◽  
Tomoki Shimokawa
Keyword(s):  
Acute Kidney Injury ◽  
Aortic Dissection ◽  
Odds Ratio ◽  
Independent Predictor ◽  
Kidney Injury ◽  
Type A ◽  
Acute Type ◽  
Operative Death ◽  
Type A Aortic Dissection ◽  
Late Mortality

Abstract OBJECTIVES This study was aimed to investigate the impact of preoperative renal malperfusion on early and late outcomes after surgery for acute type A aortic dissection (AAAD). METHODS Of 915 patients who underwent surgery for AAAD between September 2004 and September 2017, we enrolled 534 patients whose preoperative enhanced computed tomography images were retrospectively available in this study. Exclusion criteria were single kidney (n = 3) and dialysis-dependent preoperatively (n = 12). We compared early and late outcomes between patients who had preoperative renal malperfusion (n = 64) and those who did not have renal malperfusion (n = 470). RESULTS The incidence of postoperative acute kidney injury, defined using the Kidney Disease: Improving Global Outcomes criteria, was higher in the renal malperfusion group than in the no renal malperfusion group (76.6% vs 39.4%; P &lt; 0.001). Similarly, operative death was more frequently seen in the renal malperfusion group (12.5% vs 3.8%; P = 0.003). Multivariate analyses showed that renal malperfusion was the independent predictor for postoperative acute kidney injury [odds ratio 4.32, 95% confidence interval (CI) 2.25–8.67; P &lt; 0.001] and operative death (odds ratio 3.08, 95% CI 1.02–8.86; P = 0.046). The median follow-up period in the hospital survivors was 3.3 years (interquartile range 2.1–6.7 years). The cumulative survival rate at 8 years was similar between the groups (74.6% in the renal malperfusion group and 76.0% in the no renal malperfusion group; P = 0.349). CONCLUSIONS Preoperative renal malperfusion is an independent predictor for postoperative acute kidney injury and operative death but not associated with late mortality after surgery for acute type A aortic dissection.

scholarly journals Analysis of Risk Factors of Postoperative Neurological Complications in Patients with Stanford Type A Aortic Dissection Undergoing Sun’s Procedure

2021 ◽  
Vol 5 (6) ◽  
pp. 93-101
Author(s):  
Hui Zhang ◽  
Ruicheng Zhang ◽  
Hua Zhang ◽  
Feng Li ◽  
Jianming Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Type A ◽  
Neurological Complications ◽  
Neurological Dysfunction ◽  
Multivariate Logistic Regression ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Type A Aortic Dissection ◽  
Independent Risk Factors

Objective: This study analyzed the risk factors of neurological complications in patients with Stanford type A aortic dissection after Sun’s procedure in a single-center with the purpose of improving the effects. Methods: From January 2019 to December 2020, the clinical data of 480 patients with Stanford type A aortic dissection, who were treated by Sun’s procedure in our center were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to determine the risk factors of postoperative neurological complications. According to whether there were neurological complications after surgery, they were divided into two groups: the group with complications (n=70) and the group without complications (n=410). The clinical data of the two groups were collected and compared. Results: There were 70 cases of patients with postoperative neurological complications in 480 cases. The incidence rates of temporary neurological dysfunction (TND) and permanent neurological dysfunction (PND) was 11.5% (55/480) and 3.1% (15/480), respectively. Univariate analysis showed that the age (? 70 years), stroke history, femoral artery intubation and cardiopulmonary bypass (CPB) time were associated with postoperative PND (p < 0.05). Renal dysfunction, emergency surgery, postoperative hypernatremia, postoperative hyperglycemia, postoperative hypoxemia, postoperative low cardiac output syndrome, and assisted time of suction influenced the occurrence of postoperative TND (p < 0.05). Multivariate logistic regression analysis showed that age (? 70 years), stroke history, femoral artery intubation and CPB time were independent risk factors for PND. Renal dysfunction, emergency surgery, postoperative hypernatremia, postoperative hyperglycemia, postoperative hypoxemia, postoperative low cardiac output syndrome, and aspiration time were independent risk factors for TND. Compared with the two groups, the hospitalization time and ICU time of the patients in the neurological complications group were significantly prolonged, and the mortality rate was significantly increased (p < 0.05). Conclusion: There are many risk factors for neurological complications in patients with Stanford type A aortic dissection after surgery. With the improvement of surgical techniques, optimization of cerebral perfusion, and interventions for risk factors, Sun’s procedure remains the preferred treatment for Stanford type A aortic dissection.

scholarly journals Prediction Efficiency of Postoperative Acute Kidney Injury in Acute Stanford Type A Aortic Dissection Patients with Renal Resistive Index and Semiquantitative Color Doppler

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Huai Qin ◽  
Yaqiong Li ◽  
Nan Zhang ◽  
Tiezhu Wang ◽  
Zhanming Fan
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Aortic Dissection ◽  
Resistive Index ◽  
Kidney Injury ◽  
Type A ◽  
Renal Resistive Index ◽  
Early Prediction ◽  
Type A Aortic Dissection ◽  
Cutoff Value

Objectives. This study is aimed to evaluate the efficiency in early prediction of postoperative persistent acute kidney injury (PAKI) after surgery in acute Stanford type A aortic dissection (AAAD) patients by using Doppler renal resistive index (RRI) and semiquantitative color (SQC) Doppler grade, respectively. Methods. 84 AAAD patients received Sun’s surgical management, and 67 patients were enrolled. RRI and SQC Doppler grade were evaluated by ultrasonography, respectively, at 6 hours after surgery. Serum creatinine (sCr) was recorded before operation and at 24 hours, 48 hours, and 72 hours after operation. AKI grade was evaluated according to the classifications of the Acute Kidney Injury Network (AKIN). PAKI is defined as persistent oliguria and/or sCr elevation after 3 days. RRI and SQC Doppler grade were compared, respectively, between the PAKI and non-PAKI groups. Potential predictors were first tested by univariate logistic regression analysis, and a multivariate model was identified to determine the independent predictive ability of RRI and SQC Doppler grade for the PAKI. Receiver operating characteristic (ROC) analysis was performed to compare the diagnostic accuracy between RRI and SQC Doppler grade in early prediction of PAKI by using AKIN classifications as the reference standard. Results. Of a total of 67 patients enrolled during the study period, 21 (31.3%) patients suffered from PAKI and 8 (11.9%) patients required dialysis. There are significant differences in RRI (0.80 ± 0.09 vs. 0.70 ± 0.05, P=0.002) and SQC Doppler grade (x2=12.193, P=0.007) between the 2 groups with and without PAKI. Univariate analysis showed that RRI, SQC Doppler grade, length of stay in ICU, time of CPB, and length of stay in hospital were significant predictors of PAKI. RRI and the SQC Doppler grade remained independent predictors of PAKI. Area under the curve (AUC) of RRI was 0.855 (95% CI, 0.74–0.96) with cutoff value 0.725 (sensitivity 90.9% and specificity 71.1%), AUC of SQC Doppler grade was 0.642 (95% CI, 0.49–0.79) with cutoff value grade 2 (sensitivity 50% and specificity 73.3%). Conclusion. Both postoperative RRI and SQC Doppler grade are independent predictors for PAKI after surgery in AAAD patients. Both postoperative RRI and SQC Doppler grade can be obtained rapidly by bedside ultrasound, which is a good tool for early prediction for postoperative PAKI.

scholarly journals Significance of preoperative acute kidney injury in patients with acute type A aortic dissection

2019 ◽  
Vol 118 (4) ◽  
pp. 815-820 ◽  
Author(s):  
Tsu-Ming Chien ◽  
Hao Wen ◽  
Jiann-Woei Huang ◽  
Chong-Chao Hsieh ◽  
Huai-Min Chen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Aortic Dissection ◽  
Kidney Injury ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection
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