Prognosis,Risk Factors And Predictive Model Of Hepatic Dysfunction Following Aortic Surgery

Objective:At present,the prognosis and risk factors of postoperative hepatic dysfunction(HD)are not clear.The prognosis of HD and main risk factors of HD after aortic surgery should be explored,in order to reduce the incidence of HD and improve the prognosis following aortic surgery.In this study,the perioperative clinical data of patients undergoing aortic surgery were collected based on the end-stage liver disease model score(MELD-XI).The prognosis and risk factors of HD after aortic surgery were analyzed and a predictive model was established to provide a theoretical basis for the prediction and prevention of HD after aortic surgery.Methods:From June 2019 to June 2021,the patients were recruited from the Provincial Hospital affiliated to Shandong University who underwent routine aortic surgery.The perioperative clinical data were collected and statistically analyzed by SPSS Statistics 26.0 and other software.According to the preoperative diagnosis,the included patients were further divided into two subgroups as the acute aortic syndrome(AAS)subgroup and the non-AAS subgroup.The binary logistic regression analysis was employed for the univariable and multivariable analyses.When the efforts were made to construct a multivariable predictive model,all candidate variables derived from the univariable analysis as well as those possible predictive variables were selected.The receiver operating characteristic curve(ROC)curve was applied to evaluate the prediction model.Results:1.According to the MELD-XI score,223 patients(66.6%)were diagnosed with postoperative HD.2.The patients with postoperative HD had a poorer prognosis:durations of ICU stay and hospitalization were significantly prolonged;the risk of hyperbilirubinemia,hepatic failure,acute renal injury,neurological complications and low cardiac output syndrome was also significantly increased.In addition,the proportions of continuous renal replacement therapy and redo thoracotomy were higher in the patients with postoperative HD.However,postoperative HD did not increase in-hospital mortality.3.The independent risk factors of postoperative HD included gender,BMI,aortic cross-clamping time,preoperative HD,and intraoperative erythrocyte transfusion among all the included patients;the independent risk factors of postoperative HD in the AAS subgroup included preoperative albumin level and aortic cross-clamping time;and the independent risk factors of postoperative HD in non-AAS subgroup were gender,preoperative HD and intraoperative erythrocyte transfusion.4.According to the results of multivariate analysis,a predictive model was established and evaluated by ROC.The prediction model of the total population had a good fit(P=0.165),with a sensitivity of 74.4%and a specificity of 75.9%;the model of postoperative HD in the AAS group was acceptable(P=0.071),and its sensitivity was 93.3%and the specificity was 42.9%;the model of postoperative HD was better in the non-AAS group(P=0.260),with a sensitivity of 57.5%and a specificity of 85.7%.Conclusions:1.The MELD-XI score could be used to diagnose HD after aortic surgery.Because this score excludes the coagulation index INR,it is suitable for patients who undergo valve replacement during surgery and who take warfarin after surgery.2.The incidence of HD after aortic surgery is high.The prognosis of these patients is worse than that of patients with normal hepatic function.The postoperative ICU stay days,total hospitalization days and the incidence of complications increase significantly,but postoperative HD does not affect the in-hospital mortality.3.The independent risk factors of HD for overall patients include gender,BMI,aortic cross-clamping time,preoperative HD,and intraoperative red blood cell transfusion.The independent risk factors of postoperative HD in the AAS subgroup include preoperative albumin level and aortic cross-clamping time.The independent risk factors for postoperative HD in non-AAS subgroups were gender,preoperative HD and intraoperative erythrocyte transfusion.4.A prediction model for HD after aortic surgery was established,which provides a theoretical reference for medical staffs to predict and prevent HD after aortic surgery.However,future studies with larger samples are needed to further confirm the conclusions above.