Postoperative Prognostic Nutritional Index and Fibrinogen Could Well Predict Poor Prognosis of Acute Type A Aortic Dissection Patients After Surgery

Hu, Jia-Wen; Shi, Tao

doi:10.21470/1678-9741-2022-0185

Jia-Wen Hu

Substantial contributions to the conception or design of the work

or the acquisition

analysis

or interpretation of data for the work

drafting the work or revising it critically for important intellectual content

final approval of the version to be published

Department of Cardiovascular Surgery, First Affiliated Hospital of Medical School, Xi’an Jiaotong University, Xi’an, People’s Republic of China

Tao Shi Correspondence Address: Tao Shi, https://orcid.org/0000-0002-1221-5100, Department of Cardiovascular Surgery, First Affiliated Hospital of Medical School, Xi'’an Jiaotong University, No. 277, Yanta West Road, Xi’an, People’s Republic of China, Zip Code: 710061, E-mail: shi2009tao@163.com

Substantial contributions to the conception or design of the work

or the acquisition

analysis

or interpretation of data for the work

agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

final approval of the version to be published

Department of Cardiovascular Surgery, First Affiliated Hospital of Medical School, Xi’an Jiaotong University, Xi’an, People’s Republic of China

http://orcid.org/0000-0002-1221-5100

Correspondence Address: Tao Shi, https://orcid.org/0000-0002-1221-5100, Department of Cardiovascular Surgery, First Affiliated Hospital of Medical School, Xi'’an Jiaotong University, No. 277, Yanta West Road, Xi’an, People’s Republic of China, Zip Code: 710061, E-mail: shi2009tao@163.com

This study was carried out at the Department of Cardiovascular Surgery, First Affiliated Hospital of Medical School, Xi’an Jiaotong University, Xi’an, People’s Republic of China.

No conflict of interest.

Figures (2)
Tables (5)

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Fig. 1
Flow chart of screening. ATAAD=acute type A aortic dissection.

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Fig. 2
Receiver operating characteristic curves by different clinical outcomes. postFIB=postoperative fibrinogen; postPNI=postoperative prognostic nutritional index.

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Abbreviations, Acronyms & Symbols AD = Aortic dissection HTN = Hypertension ALI = Advanced lung cancer inflammation index ICU = Intensive care unit ALT = Alanine aminotransferase IDBIL = Indirect bilirubin AST = Aspartate aminotransferase IL-6 = Interleukin-6 ATAAD = Acute type A aortic dissection MHCA = Mild hypothermic circulatory arrest AUC = Area under the curve MV = Mechanical ventilation BMI = Body mass index NLR = Neutrophil-lymphocyte ratio BUN = Blood urea nitrogen OR = Odds ratio CABG = Coronary artery bypass grafting PCT = Procalcitonin CI = Confidence interval PIV = Pan-immune-inflammation value CKD = Chronic kidney disease PLT = Platelet CPB = Cardiopulmonary bypass PNI = Prognostic nutritional index Cre = Creatinine postFIB = Postoperative fibrinogen CRP = C-reactive protein postPNI = Postoperative prognostic nutritional index DBIL = Direct bilirubin RBC = Red blood cell DD = D-dimer ROC = Receiver operating characteristic DM = Diabetes mellitus SII = Systemic immune-inflammation index FDP = Fibrinogen degradation products SIRI = Systemic inflammation response index FIB = Fibrinogen TBIL = Total bilirubin Hb = Hemoglobin WBC = White blood cell

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Table 1
Baseline characteristics of acute type A aortic dissection patients by different clinical outcomes.

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Table 2
Perioperative immune-inflammatory parameters by different clinical outcomes.

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Table 3
Prognostic parameters screened by univariate and multivariate logistic regression analysis.

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Table 4
ROC analysis of postPNI and postFIB by different clinical outcomes.

Abbreviations, Acronyms & Symbols
AD	= Aortic dissection	HTN	= Hypertension
ALI	= Advanced lung cancer inflammation index	ICU	= Intensive care unit
ALT	= Alanine aminotransferase	IDBIL	= Indirect bilirubin
AST	= Aspartate aminotransferase	IL-6	= Interleukin-6
ATAAD	= Acute type A aortic dissection	MHCA	= Mild hypothermic circulatory arrest
AUC	= Area under the curve	MV	= Mechanical ventilation
BMI	= Body mass index	NLR	= Neutrophil-lymphocyte ratio
BUN	= Blood urea nitrogen	OR	= Odds ratio
CABG	= Coronary artery bypass grafting	PCT	= Procalcitonin
CI	= Confidence interval	PIV	= Pan-immune-inflammation value
CKD	= Chronic kidney disease	PLT	= Platelet
CPB	= Cardiopulmonary bypass	PNI	= Prognostic nutritional index
Cre	= Creatinine	postFIB	= Postoperative fibrinogen
CRP	= C-reactive protein	postPNI	= Postoperative prognostic nutritional index
DBIL	= Direct bilirubin	RBC	= Red blood cell
DD	= D-dimer	ROC	= Receiver operating characteristic
DM	= Diabetes mellitus	SII	= Systemic immune-inflammation index
FDP	= Fibrinogen degradation products	SIRI	= Systemic inflammation response index
FIB	= Fibrinogen	TBIL	= Total bilirubin
Hb	= Hemoglobin	WBC	= White blood cell

Index	Delayed extubation			Reintubation			30-day mortality
Index	Yes	No	P-value	Yes	No	P-value	Yes	No	P-value
	(N=52)	(N=67)	P-value	(N=19)	(N=94)	P-value	(N=16)	(N=111)	P-value
Age, years	51.71±11.24	51.54±11.43	0.934	54.53±11.79	51.18±11.43	0.249	52.31±11.41	51.39±11.54	0.765
Sex, male/female	36/16	53/14	0.219	12-jul.	73/21	0.182	11-mai.	83/28	0.607
BMI, kg/m²	26.29±3.91	25.32±3.73	0.176	25.75±3.84	25.80±4.14	0.962	27.23±5.21	25.84±3.89	0.233
HTN, %	48%	51%	0.773	53%	48%	0.705	56%	49%	0.570
DM, %	2%	3%	0.714	5%	2%	0.438	0%	3%	0.506
CKD, %	2%	7%	0.171	10%	4%	0.266	0%	6%	0.301
Smoking, %	35%	48%	0.130	26%	47%	0.093	38%	43%	0.643
Malperfusion, %	58%	13%	0.003	37%	18%	0.119	31%	22%	0.523
Operation data
Bentall procedure	7	25	< 0.001	3	28	0.350	1	31	0.175
David procedure	5	1		1	4		1	5
CABG	2	0	0.186	0	1	0.817	1	1	0.237
Ascending-femoral bypass	2	2	0.626	1	3	0.559	3	4	0.042
Surgery time, h	6.81±1.52	6.63±1.39	0.525	7.67±1.26	6.87±1.35	0.004	7.61±1.20	6.68±1.48	0.017
CPB time, min	175.63±41.74	150.44±31.91	0.001	171.36±35.20	156.43±38.20	0.179	172.64±31.17	158.53±38.27	0.244
Cross-clamping time, min	96.34±28.37	88.51±19.97	0.120	97.14±20.58	90.14±23.02	0.292	94.45±29.84	91.35±22.79	0.682
MHCA time, min	21.43±4.33	21.72±5.03	0.782	21.79±3.45	21.38±4.72	0.765	23.00±5.48	21.40±4.53	0.289
Blood transfusion, ml	929.33±461.29	1075.00±360.16	0.064	957.14±516.49	1043.55±382.83	0.385	946.88±514.37	1028.18±398.49	0.465
RBC, U	3.36±1.97	4.49±2.01	0.011	3.48±2.14	4.30±2.00	0.096	3.81±2.17	4.15±2.03	0.534
Plasma, ml	403.85±251.24	422.06±244.85	0.690	432.98±235.27	380.95±287.44	0.381	337.5±289.54	426.13±239.59	0.181
Platelet, U^*	1.85±0.60	1.61±0.54	0.773	4.19±1.46	1.14±0.36	0.054	2.50±1.12	1.58±0.41	0.429
Cryoprecipitate, U^*	1.48±0.53	2.02±0.55	0.483	1.48±0.70	1.77±0.45	0.776	2.81±0.99	1.72±0.40	0.334
Laboratory parameters at admission
Hb, g/L	128.78±24.59	133.17±24.79	0.367	124.35±20.50	131.44±24.82	0.273	128.54±24.97	129.93±24.66	0.849
WBC, 10^9/L	11.27±4.21	12.61±5.75	0.173	12.47±5.69	11.34±4.08	0.333	13.13±8.97	11.51±4.21	0.271
PLT, 10^9/L	167.22±53.43	156.59±52.83	0.312	144.65±67.80	164.21±49.26	0.166	148.31±66.16	161.77±51.91	0.397
AST, U/L	20.00 [18.00,26.00]	24.50 [19.25,43.75]	0.027	21.00 [18.00,26.00]	27.00 [30.00,43.50]	0.670	25.00 [17.50,61.75]	22.00 [18.50,26.50]	0.371
ALT, U/L	24.50 [19.25,43.75]	34.50 [27.00,42.75]	0.050	30.00 [25.00,38.00]	32.00 [27.50,43.50]	0.655	28.50 [20.25,49.50]	31.00 [51.50,111.50]	0.370
TBIL, µmol/L	19.35±8.01	21.61±13.62	0.294	19.65±9.18	20.45±10.86	0.776	17.18±10.08	20.53±10.56	0.299
DBIL, µmol/L	5.79±2.25	7.06±3.99	0.062	7.47±3.82	6.07±2.95	0.094	6.49±2.60	6.39±3.19	0.913
IDBIL, µmol/L	13.39±8.26	14.54±12.25	0.569	12.18±7.93	14.26±10.44	0.439	10.68±8.20	14.04±10.11	0.271
BUN, mmol/L	8.02±4.74	8.69±4.01	0.450	10.12±5.23	7.92±4.20	0.063	9.11±3.31	8.47±4.70	0.652
Cre, µmol/L	66.00 [48.00,105.00]	82.50 [61.00,107.25]	0.274	68.50 [47.50,96.00]	86.00 [64.50,126.00]	0.181	101.00 [82.5,181.00]	72.00 [51.50,111.50]	0.716
FIB, g/L	2.60 [2.02,3.92]	2.30 [1.79,3.26]	0.060	2.52 [2.00,3.84]	1.99 [1.67,2.94]	0.238	2.02 [1.62,3.09]	2.48 [1.99,3.75]	0.099
DD, mg/L	7.16 [1.87,11.02]	12.97 [6.83,30.78]	0.011	7.70 [2.12,17.10]	10.90 [7.78,18.86]	0.654	34.75 [5.24,53.61]	8.05 [2.48,17.10]	0.026
FDP, mg/L	21.72 [5.75,33.13]	39.40 [21.62,87.76]	0.005	24.25 [7.07,52.25]	37.03 [23.97,62.03]	0.736	75.32 [15.76,22.12]	25.18 [8.64,50.55]	0.026
CRP, mg/L	14.90 [5.95,48.10]	6.65 [3.40,60.68]	0.857	10.46 [4.96,48.60]	51.30 [9.87,108.20]	0.360	6.19 [0.91,51.3]	11.70 [5.34,53.25]	0.429
PCT, ng/mL	0.24 [0.13,0.50]	0.39 [0.10,1.60]	0.088	0.24 [0.10,0.57]	1.10 [0.35,1.33]	0.775	0.32 [0.12,0.71]	0.34 [0.10,1.00]	0.476
Postoperative laboratory parameters
Hb, g/L	103.92±19.32	101.93±13.38	0.526	101.48±17.00	102.53±15.63	0.784	101.36±22.23	102.77±15.30	0.758
WBC, 10^9/L	12.40±3.79	12.79±4.28	0.322	13.54±4.44	12.39±3.98	0.127	12.36±3.20	12.68±4.08	0.356
PLT, 10^9/L	69.60±36.17	75.96±33.55	0.607	62.81±38.40	75.49±33.20	0.246	64.21±32.07	73.28±34.80	0.783
AST, U/L	76.50 [45.50,185.50]	53.50 [40.25,79.25]	0.008	86.00 [50.50,247.00]	57.00 [40.75,83.25]	0.598	97.00 [62.75,440.75]	59.00 [41.00,97.00]	0.225
ALT, U/L	37.50 [27.00,76.50]	31.00 [26.00,44.00]	0.021	37.00 [28.50,70.50]	32.00 [26.00,44.25]	0.766	55.50 [28.75,134.00]	32.00 [26.00,48.00]	0.323
TBIL, µmol/L	49.98±23.53	42.70±24.11	0.100	55.82±28.85	43.85±22.62	0.040	43.05±19.84	45.73±24.22	0.692
DBIL, µmol/L	20.21±11.91	15.78±13.01	0.057	23.10±18.15	16.57±11.20	0.036	16.89±8.04	17.54±12.99	0.856
IDBIL, µmol/L	29.77±16.84	26.92±14.25	0.318	32.72±17.54	27.27±14.63	0.140	26.16±18.42	28.20±14.93	0.640
BUN, mmol/L	14.92±5.35	12.96±5.00	0.041	16.33±5.89	13.30±4.94	0.016	14.25±5.34	13.73±5.19	0.727
Cre, µmol/L	166.50 [104.50,244.75]	104.50 [80.00,163.00]	0.094	162.00 [103.50,211.50]	109.50 [80.00,191.75]	0.281	176.50 [108.25,253.25]	115.00 [86.00,194.00]	0.426
FIB, g/L	2.72 [10.92,3.17]	3.08 [2.55,3.64]	0.001	2.27 [1.81,2.91]	3.04 [2.58,3.58]	0.001	1.99 [1.79,3.00]	2.99 [2.48,3.48]	0.003
DD, mg/L	15.86 [10.92,20.05]	16.19 [8.86,20.36]	0.277	16.14 [11.57,21.85]	15.84 [9.00,20.10]	0.576	15.88 [14.14,26.76]	15.90 [9.55,20.11]	0.070
FDP, mg/L	59.23 [42.61,77.37]	54.78 [36.28,77.43]	0.369	57.73 [38.16,80.35]	55.41 [39.96,75.00]	0.951	59.23 [45.90,99.77]	55.04 [37.28,77.16]	0.248
CRP, mg/L	97.40 [75.23,145.10]	114.60 [49.50,160.40]	0.667	103.95 [61.48,135.53]	105.60 [67.50,156.40]	0.424	113.05 [70.55,155.43]	82.35 [27.28,119.13]	0.047
PCT, ng/mL	9.70 [4.15,17.00]	7.70 [2.80,16.00]	0.572	11.50 [3.97,21.25]	9.00 [3.40,16.00]	0.846	7.50 [2.40,21.00]	9.40 [3.40,16.00]	0.714
IL-6	134.57±73.24	104.60±80.07	0.291	119.69±77.72	113.52±80.84	0.866	145.53±17.99	113.08±78.44	0.568

Index^*	Delayed extubation			Reintubation			30-day mortality
Index^*	Yes	No	P-value	Yes	No	P-value	Yes	No	P-value
Pre. SIRI	8.36 [3.70,15.46]	5.84 [3.38,7.82]	0.025	6.02 [3.41.10.10]	7.04 [4.56,15.30]	0.743	10.92 [3.57,19.61]	6.28 [3.58,9.79]	0.297
Pre. SII	2219.9 [1321.4,3165.5]	1344.69 [989.44,2449.30]	0.063	1720.5 [1072.3,3343.5]	1892.6 [1039.7,2595.5]	0.890	2612.6 [719.8,3908.3]	1874.1 [1039.7,2599.3]	0.577
Pre. ALI	6.18 [3.79, 12.21]	9.22 [5.77,14.00]	0.153	9.06 [4.71,12.23]	8.20 [5.12,13.09]	0.268	6.60 [3.48,8.74]	8.39 [5.20,12.38]	0.166
Pre. PNI	38.94±5.84	41.78±4.39	0.006	38.87±5.69	40.96±4.86	0.105	38.49±7.14	40.50±5.08	0.220
Pre. PIV	1171.9 [668.8,2356.4]	801.61 [510.74,1208.55]	0.039	940.5 [563.3,1699.2]	939.6 [688.8,2463.4]	0.533	1659.8 [265.0,3298.5]	1427.3 [960.2,2680.3]	0.250
Post. SIRI	12.72 [9.33,15.16]	12.52 [9.87,16.61]	0.295	12.52 [9.43,15.80]	12.11 [9.73,17.56]	0.769	11.89 [8.86,14.33]	12.60 [9.85,15.93]	0.547
Post. SII	1466.1 [668.8,2356.4]	1428.5 [1150.0,2845.8]	0.678	1165.7 [548.4,2178.3]	1437.7 [1083.0,2780.4]	0.079	1065.6 [388.6,1820.2]	1427.3 [960.2,2680.3]	0.099
Post. ALI	4.07 [2.91,7.86]	4.29 [3.08,6.07]	0.966	4.60 [3.08,7.42]	4.10 [2.99,6.20]	0.782	4.89 [3.41,8.76]	4.13 [3.04,6.18]	0.417
Post. PNI	40.05±4.89	42.55±4.13	0.003	39.51±5.95	42.01±4.30	0.027	36.31±6.82	41.93±4.18	0.009
Post. PIV	757.1 [351.0,1497.7]	934.0 [553.8,1877.6]	0.480	803.3 [192.1,1538.5]	889.5 [548.1,1814.5]	0.341	565.1 [130.8,1501.6]	910.2 [541.6,1726.6]	0.464

Index^*	Delayed extubation			Reintubation			30-day mortality
Index^*	P-value	OR	95% CI	P-value	OR	95% CI	P-value	OR	95% CI
Univariate logistic regression
BMI	0.047	1.122	1.002, 1.258
Malperfusion	0.004	3.774	1.534, 9.286
CPB time	0.006	1.017	1.005, 1.029	0.046	1.676	1.010,2.783
Pre. DD	0.012	1.037	1.008, 1.067				0.003	1.041	1.014,1.068
Pre. FDP	0.009	1.014	1.004, 1.024				0.003	1.012	1.004,1.019
Pre. PNI	0.012	0.899	0.828, 0.977
Post. FIB	0.001	0.423	0.253,0.705	0.008	0.292	0.118, 0.720	0.004	0.256	0.102,0.643
Post. PNI	0.016	0.903	0.832,0.981	0.040	0.902	0.817,0.995	0.001	0.811	0.720,0.913
Multivariate logistic regression^**
CPB time	0.020	1.016	1.003,1.030
Post. FIB	0.006	0.487	0.291,0.813	0.005	0.292	0.124, 0.687	0.006	0.249	0.093,0.669
Post. PNI	0.029	0.898	0.815,0.989	0.072	0.908	0.817,1.009	<0.001	0.792	0.696,0.901

Index	Delayed extubation		Reintubation		30-day mortality
Index	postPNI	postFIB	postPNI	postFIB	postPNI	postFIB
AUC	0.659	0.678	0.603	0.751	0.746	0.745
95% CI	0.567,0.743	0.584,0.762	0.507,0.693	0.659,0.828	0.661,0.820	0.656,0.821
Sensitivity	65.4	62.5	52.4	70.0	64.3	61.5
Specificity	63.2	66.7	64.9	77.5	79.3	88.5
Cutoff value	42.1	2.87	40.3	2.54	38.55	2.08

[1] Correspondence Address: Tao Shi, https://orcid.org/0000-0002-1221-5100, Department of Cardiovascular Surgery, First Affiliated Hospital of Medical School, Xi'’an Jiaotong University, No. 277, Yanta West Road, Xi’an, People’s Republic of China, Zip Code: 710061, E-mail: shi2009tao@163.com

Brasil

Brasil

Postoperative Prognostic Nutritional Index and Fibrinogen Could Well Predict Poor Prognosis of Acute Type A Aortic Dissection Patients After Surgery

ABSTRACT

Introduction:

Methods:

Results:

Conclusion: