Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, 221 85, Lund, Sweden.
Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden.
J Cardiothorac Surg. 2023 Feb 6;18(1):62. doi: 10.1186/s13019-023-02151-2.
Neurological injuries are frequent following Acute Type A Aortic Dissection (ATAAD) repair occurring in 4-30% of all patients. Our objective was to study whether S100B can predict neurological injury following ATAAD repair.
This was a single-center, retrospective, observational study. The study included all patients that underwent ATAAD repair at our institution between Jan 1998 and Dec 2021 and had recorded S100B-values. The primary outcome measure was neurological injury, defined as focal neurological deficit or coma diagnosed by clinical assessment with or without radiological confirmation and with a symptom duration of more than 24 h. Secondary outcome measure was 30-day mortality.
538 patients underwent surgery during the study period and 393 patients, had recorded S100B-values. The patients had a mean age of 64.4 ± 11.1 years and 34% were female. Receiver operating characteristic curve for S100B 24 h postoperatively yielded area under the curve 0.687 (95% CI 0.615-0.759) and best Youden's index corresponded to S100B 0.225 which gave a sensitivity of 60% and specificity of 75%. Multivariable logistic regression identified S100B ≥ 0.23 μg/l at 24 h as an independent predictor for neurological injury (OR 4.71, 95% CI 2.59-8.57; p < 0.01) along with preoperative cerebral malperfusion (OR 4.23, 95% CI 2.03-8.84; p < 0.01) as well as an independent predictor for 30-day mortality (OR 4.57, 95% CI 1.18-11.70; p < 0.01).
We demonstrated that S100B, 24 h after surgery is a strong independent predictor for neurological injury and 30-day mortality after ATAAD repair.
As this was a retrospective observational study it was not registered.
急性 A 型主动脉夹层（ATAAD）修复后常发生神经系统损伤，发生率为 4%至 30%。我们的目的是研究 S100B 是否可预测 ATAAD 修复后的神经损伤。
这是一项单中心、回顾性、观察性研究。该研究纳入了 1998 年 1 月至 2021 年 12 月在我院接受 ATAAD 修复的所有患者，记录了 S100B 值。主要观察指标为神经系统损伤，定义为通过临床评估诊断的局灶性神经功能缺损或昏迷，伴有或不伴有影像学证实，症状持续时间超过 24 小时。次要观察指标为 30 天死亡率。
研究期间共 538 例患者接受手术，其中 393 例患者记录了 S100B 值。患者平均年龄为 64.4±11.1 岁，34%为女性。术后 24 小时 S100B 的受试者工作特征曲线下面积为 0.687（95%置信区间 0.615-0.759），最佳 Youden 指数对应的 S100B 值为 0.225，其敏感性为 60%，特异性为 75%。多变量逻辑回归确定术后 24 小时 S100B≥0.23μg/l 为神经系统损伤的独立预测因子（OR 4.71，95%置信区间 2.59-8.57；p<0.01），以及术前脑灌注不良（OR 4.23，95%置信区间 2.03-8.84；p<0.01）为 30 天死亡率的独立预测因子（OR 4.57，95%置信区间 1.18-11.70；p<0.01）。
我们证明了术后 24 小时 S100B 是 ATAAD 修复后神经系统损伤和 30 天死亡率的强独立预测因子。
由于这是一项回顾性观察性研究，因此未进行注册。
