The Nephrology Department of Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China.
State Key Laboratory of Kidney Disease, Department of Nephrology, Chinese People's Liberation Army General Hospital and Military Medical Postgraduate College, Beijing, China.
J Card Surg. 2021 Apr;36(4):1320-1327. doi: 10.1111/jocs.15392. Epub 2021 Feb 2.
Severe acute kidney injury (AKI) and hyperbilirubinemia increase the morbidity and mortality risk in patients undergoing emergency surgery for acute type A aortic dissection (AAAD). Our purpose was to investigate the risk factors of mortality in AAAD surgery patients who had severe postoperative hyperbilirubinemia and AKI receiving continuous renal replacement therapy (CRRT).
Patients who had severe hyperbilirubinemia and received CRRT after AAAD surgery in our center between January 2015 and December 2018 were retrospectively screened. Univariate and multivariate analyses were performed to identify the risk factors of in-hospital mortality. Kaplan-Meier curves were employed to evaluate the accumulated patient survival proportion.
After screening, 50 patients were included in our present study. The in-hospital mortality was 84%. The univariate logistic analysis showed that preoperative MAP (p = .017) and peak total bilirubin concentration (p < .001) were associated with in-hospital mortality in AAAD surgery patients who had severe postoperative hyperbilirubinemia and received CRRT. Multivariate logistic regression analysis revealed that the peak bilirubin concentration (odds ratio, 1.050; 95% confidence interval, 1.002-1.101; p = .041) after surgery was the only independent risk factor for in-hospital mortality. The optimal cutoff value of peak bilirubin for predicting in-hospital mortality was 134.4 μmol/L.
AAAD surgery patients with severe hyperbilirubinemia and AKI requiring CRRT had a poor prognosis. Increased postoperative peak bilirubin concentration strongly increased the risk of patient in-hospital mortality. Therefore, these patients should be closely monitored and treated aggressively when possible.
严重急性肾损伤（AKI）和高胆红素血症会增加接受急性 A 型主动脉夹层（AAAD）急诊手术患者的发病率和死亡率。我们的目的是研究在因严重术后高胆红素血症和 AKI 而接受连续性肾脏替代治疗（CRRT）的 AAAD 手术患者中，导致死亡率的危险因素。
回顾性筛选了 2015 年 1 月至 2018 年 12 月期间在我院因 AAAD 手术而发生严重高胆红素血症并接受 CRRT 的患者。采用单因素和多因素分析来确定院内死亡率的危险因素。采用 Kaplan-Meier 曲线评估累积患者生存率。
经过筛选，本研究共纳入 50 例患者。院内死亡率为 84%。单因素 logistic 分析显示，术前平均动脉压（MAP）（p = .017）和峰值总胆红素浓度（p < .001）与因严重术后高胆红素血症和接受 CRRT 的 AAAD 手术患者的院内死亡率相关。多因素 logistic 回归分析显示，术后峰值胆红素浓度（优势比，1.050；95%置信区间，1.002-1.101；p = .041）是院内死亡率的唯一独立危险因素。预测院内死亡率的最佳峰值胆红素截断值为 134.4 μmol/L。
因严重高胆红素血症和 AKI 需要接受 CRRT 的 AAAD 手术患者预后不良。术后峰值胆红素浓度升高强烈增加了患者院内死亡的风险。因此，当可能时，这些患者应密切监测并积极治疗。
