Characteristics and outcomes of Stanford type A aortic dissection patients with post-operation severe hyperbilirubinemia: a retrospective cohort study

Abstract

Objective Hyperbilirubinemia is one of the common complications after cardiac surgery and is associated with increased mortality. However, to the best of our knowledge, the report on clinical significance of postoperative severe hyperbilirubinemia in Stanford type A aortic dissection (AAD) patients is limited. Therefore, the purpose of our present study is to assess the characteristics and outcomes of AAD patients with post-operation severe hyperbilirubinemia.Methods Patients who underwent surgical treatment for AAD in our center between January 2015 and December 2018 were retrospectively screened. In-hospital mortality, long-term mortality, acute kidney injury (AKI), and the requirement of continuous renal replacement therapy (CRRT) were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of these endpoints.Results Of the 2210 screened patients, 271 (12.3%) were included. Of the included patients, 222 (81.9%) experienced postoperative AKI, and 50 (18.5%) received CRRT. In-hospital mortality was 30.3%. The 1-year, 2-year, and 3-year cumulative mortality were 32.9%, 33.9%, and 35.3%, respectively. Multivariate Logistic regression analysis indicated that age ( P < 0.033), AKI stage 3 ( P < 0.001), the total amount of blood transfusion after surgery ( P = 0.019), mean arterial pressure (MAP) in the first postoperative day ( P = 0.012), the use of extracorporeal membrane oxygenation (ECMO) after surgery ( P = 0.02), and the peak total bilirubin (TB) concentration ( P = 0.023) were independent risk factors of in-hospital mortality. The optimal cut-off value of peak TB on predicting in-hospital mortality was 121.2 μmol/l. Older age, high preoperative serum creatinine (SCr) concentration, and prolonged cardiopulmonary bypass (CPB) time were identified as the independent risk factors of AKI. High preoperative SCr concentration was identified as the only independent risk factor of the requirement of CRRT.Conclusions Post-operation severe hyperbilirubinemia is a common clinical presentation in AAD surgery patients. Post-operation severe hyperbilirubinemia AAD patients with older age, lower MAP, increased blood transfusion, stage 3 AKI, the use of ECMO, and the increased peak TB had higher risk of in-hospital mortality.

Impact of hyperbilirubinemia associated acute kidney injury on chronic kidney disease after aortic arch surgery: a retrospective study with follow-up of 1 year

“…The hemolysis occurs and bilirubin is increasing gradually during CPB [16]. The postoperative peak total bilirubin level was at the second or third day after aortic arch surgery [4,13], which was consistent with our study (data was not shown). Furthermore, although the majority of AKI occurs within the rst 2-3 postoperative days according to the increase of sCr [17], diagnosis of the AKI delays using the elevation of sCr owing to the rate-limiting step of sCr production and release by skeletal muscle [18].…”

“…The ischemia and reperfusion is considered to be the main reason for AKI and other factors may exacerbate AKI [3]. Hyperbilirubinemia (HB) remains a prevalent postoperative complication in aortic arch surgery [4].…”

“…Bilirubin is a metabolic end product of heme degradation by the liver. Hemolysis caused by CPB, hepatic hypoperfusion and perioperative blood transfusion may disrupt the bilirubin metabolism and lead to HB [4,5]. HB is associated with AKI after CPB [5].…”

Bilirubin adsorption for the treatment of severe hyperbilirubinemia after cardiac surgery: A retrospective cohort study

“…1 Post-cardiac surgery hyperbilirubinemia is common, with an incidence of about 20–51%, 2–7 which may result from factors associated with cardiopulmonary bypass (CPB), such as hemolysis, hypoperfusion, and systemic inflammatory response, and also may be associated with secondary hepatic dysfunction due to heart failure or sepsis. 4,8 Post-cardiac-surgery hyperbilirubinemia is associated with longer hospital stay and a mortality of up to 30%. In patients with hepatic failure after cardiac surgery, the in-hospital mortality could be as high as 90%.…”