C-reactive Protein Is Related to Impaired Oxygenation in Patients With Acute Aortic Dissection

Komukai, Kimiaki; Shibata, Takahiro; Mochizuki, Seibu

doi:10.1536/ihj.46.795

Cited by 36 publications

(41 citation statements)

References 13 publications

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“…The incidence of presurgical mild ARDS in this series was similar to other series which reported the incidence of 30-45%, [1][2][3][4][5] and this study showed that patients in the mild-ARDS group, compared with the no-ARDS group, had significantly higher plasma levels of inflammatory marker, C-reactive protein, which was consistent with the findings of previous studies. [17][18][19] So, this study again suggested that systemic inflammation played an important role in the occurrence and development of mild ARDS.…”

Section: Discussionsupporting

confidence: 59%

Impact of Presurgical Mild Acute Respiratory Distress Syndrome on Surgical Mortality After Surgical Repair of Acute Type A Aortic Dissection

Lai²,

Sun

et al. 2017

Int. Heart J.

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SummaryTo evaluate the impact of presurgical mild acute respiratory distress syndrome (ARDS) on surgical mortality in patients undergoing surgical repair of acute type A aortic dissection by means of deep hypothermic circulatory arrest (DHCA) in a single-center, retrospective study.From January 2011 to December 2015, 333 eligible patients were divided into either a mild-ARDS group (n = 136) or a no-ARDS group (n = 197). The definition of mild ARDS referred to the recent revision of ARDS definition (Berlin criteria). The surgical mortality and major postoperative morbidity were investigated and analyzed.A total of 136 patients developed presurgical mild ARDS, with an incidence of 40.8%. No significant difference emerged between the 2 groups in major postoperative morbidity except for pulmonary complications. Multivariate logistic regression displayed that the risk of postoperative pulmonary complications in patients with presurgical mild ARDS was 4.25 times that in patients without presurgical ARDS (OR = 4.25, 95% CI 2.05-7.72). Twenty-four patients died after surgery, with significantly higher surgical mortality in the mild-ARDS group compared with the no-ARDS group (12.5% versus 3.6%, P = 0.002). Kaplan-Meier curves showed a poor surgical survival in the mild-ARDS group (χ 2 =12.958, Log-Rank P < 0.001). And Cox regression revealed the hazard ratio for surgical mortality in the mild-ARDS group compared with the no-ARDS group was 2.52 (95%CI 1.41-5.32, P = 0.016).Presurgical mild ARDS increased postoperative respiratory morbidity, and then increased surgical mortality after surgical repair of acute type A aortic dissection by means of DHCA (Int Heart J 2017; 58: 739-745) Key words: Mild acute respiratory distress syndrome, Acute type A aortic dissection, Deep hypothermic circulatory arrest, Surgical mortality, Morbidity A cute lung injury, which was used to describe mild acute respiratory distress syndrome (ARDS) previously, is one of most common presurgical complications following acute aortic dissection, with a prevalence of 30-45%. [1][2][3][4] Although it is recognized that activation of the inflammatory system caused by aortic injury due to acute aortic dissection may play a crucial role in the occurrence and development of acute lung injury, 1,5,6) the specific mechanism is still unclear. Acute lung injury or even severe ARDS is considered to be systemic complications of acute aortic dissection rather than a simple pulmonary disease. 7)An overwhelming majority of previous studies focused on evaluating risk factors for presurgical mild ARDS following acute aortic dissection, identifying the predictors for hypoxemia following surgical repair of acute type A aortic dissection by means of deep hypothermic circulatory arrest (DHCA), and exploring the pathogenesis of postoperative hypoxemia. However, few reports focused on evaluating the impacts of presurgical mild ARDS on surgical mortality and major postoperative morbidity in patients undergoing surgical repair of acute type A aortic dissection by means of DHC...

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Section: Discussionsupporting

confidence: 59%

Impact of Presurgical Mild Acute Respiratory Distress Syndrome on Surgical Mortality After Surgical Repair of Acute Type A Aortic Dissection

Lai²,

Sun

et al. 2017

Int. Heart J.

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“…CRP was reportedly normal at admission in most AAD patients (19,20). Therefore, it is likely that the elevation of admission CRP was not caused by AAD but by other forms of chronic inflammation which existed before the onset of AAD.…”

Section: Discussionmentioning

confidence: 94%

Admission Values of D-dimer and C-reactive Protein (CRP) Predict the Long-term Outcomes in Acute Aortic Dissection

et al. 2016

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Objective Admission D-dimer and C-reactive protein (CRP) values have been reported to predict the shortterm outcomes in acute aortic dissection (AAD). However, the association between D-dimer values and the long-term outcomes has not been investigated. Methods The primary endpoints included events determined to be all-cause death, recurrence of aortic dissection, aortic rupture, and surgical intervention for the aortic aneurysm following the first hospital discharge. We performed a receiver operating characteristic analysis and determined the optimal cut-off levels of admission D-dimer, admission CRP and peak CRP values in terms of the sensitivity and specificity for predicting the presence of events. Using the optimal cut-off values, we performed a multiple Cox analysis and investigated the hazard ratio of admission D-dimer, admission CRP and peak CRP. Patients We retrospectively identified 173 AAD patients hospitalized between January 2005 and December 2013. Results A multiple Cox regression analysis revealed that the hazard ratios were 3.4 for admission D-dimer [95% Confidence Interval (CI) 1.5 to 7.3, p=0.004] and 2.7 for admission CRP (95% CI 1.2 to 5.5, p= 0.014). Conclusion Admission D-dimer and CRP values may predict the long-term outcomes in AAD. Moreover, admission D-dimer values may be a valuable marker to predict not only the short-term outcomes, but also the long-term outcomes in AAD.

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“…Maximal CRP was only predicting the impaired oxygenation, but not Stanford type, thrombosed false lumen, pleural effusion, atelectasis, and intravenous vasodilator use. At admission, CRP was normal and increased significantly since day 2 in the impaired oxygenation group [48]. Increased admission CRP correlated with high mortality irrespective of management policy [49].…”

Section: D-dimer and Aortic Diseasesmentioning

confidence: 89%

Níveis plasmáticos elevados do dímero D e da proteína C reativa hipersensíveis podem indicar desordens aórticas

Yuan

Shi

Wang

et al. 2011

Rev Bras Cir Cardiovasc

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Objective: D-dimer and C-reactive protein are of diagnostic and predictive values in patients have thrombotic tendency, such as vascular thrombosis, coronary artery disease and aortic dissection. However, the comparative study in these biomarkers between the patients with acute aortic dissection and coronary artery disease has not been sufficiently elucidated.Methods: Consecutive surgical patients for acute type A aortic dissection (20 patients), aortic aneurysm (nine patients) or coronary artery disease (20 patients) were selected into this study. Plasma from preoperative blood samples and supernatant of aortic homogenate of the surgical specimens were detected for D-dimer and hypersensitive C-reactive protein (hs-CRP).Results: Plasma D-dimer and hs-CRP values in type A aortic dissection or aortic aneurysm were much higher than in coronary artery disease patients or the healthy control (for D-dimer, aortic dissection: coronary artery disease, 0.4344 ± 0.2958 µg/ml vs. 0.0512 ± 0.0845 µg/ml, P < 0.0001; aortic dissection: healthy control, 0.4344 ± 0.2958 µg/ml vs. 0.1250 ± 0.1295 µg/ml, P = 0.0005; aortic aneurysm: coronary artery disease, 0.4200 ± 0.4039 µg/ml vs. 0.0512 ± 0.0845 µg/ml, P = 0.0013; and aortic aneurysm: healthy control, 0.4200 ± 0.4039 µg/ml vs. 0.1250 ± 0.1295 µg/ml, P = 0.0068; and for hs-CRP, aortic dissection: coronary artery disease, 4. Rev Bras Cir Cardiovasc 2011;26(4):573-81

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C-reactive Protein Is Related to Impaired Oxygenation in Patients With Acute Aortic Dissection

Cited by 36 publications

References 13 publications

Impact of Presurgical Mild Acute Respiratory Distress Syndrome on Surgical Mortality After Surgical Repair of Acute Type A Aortic Dissection

Impact of Presurgical Mild Acute Respiratory Distress Syndrome on Surgical Mortality After Surgical Repair of Acute Type A Aortic Dissection

Admission Values of D-dimer and C-reactive Protein (CRP) Predict the Long-term Outcomes in Acute Aortic Dissection

Níveis plasmáticos elevados do dímero D e da proteína C reativa hipersensíveis podem indicar desordens aórticas

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