Analysis Of Risk Factors Of Delirium And Acute Kidney Injury After Type A Aortic Dissection

Chapter 1:A retrospective study on the risk factors of postoperative delirium in patients with type A aortic dissectionObjective: A retrospective study was conducted to determine the risk factors associated with postoperative delirium(POD)in patients with type A aortic dissection.Methods: The clinical data of 148 patients with type A aortic dissection admitted to the intensive care unit of our hospital were analyzed retrospectively.All patients were treated with surgery and anesthesia.The mental disorders of these patients were evaluated by confusion assessment method for the intensive care unit(CAM-ICU).According to whether the occurrence of postoperative delirium,divided into two groups: delirium group and the control group.POD rate as the dependent variable,anterograde selective cerebral perfusion(ASCP)time,irritability and Kidney diseases Improving Global Outcomes(KDIGO)classifying acute kidney injury(I,II,III)as independent variables,such as multivariate Logistic regression analysis,to identify independent risk factors of POD.Results:The average age of the patients was(54.41 ±11.67)years old.POD 68 was detected in 45.95% of the 148 patients.Univariate analysis showed that Age,irritability,alcohol consumption,cardiopulmonary bypass(CPB)time,ASCP time,lowest partial pressure of oxygen(lowest PO2),mechanical ventilation time,bleeding volume,low PO2 and oxygenation index,hemoglobin(Hb),intensive care unit(ICU)hospitalization time,serum creatinine,and KDIGO grading were related to the occurrence of POD in patients with type A aortic dissection.Multivariate Logistic regression analysis showed that.ASCP,irritability and KDIGO grading(I,II,III)were independent risk factors for POD.The OR values(95%CI)were 5.95(1.20-29.47),4.77(1.71-13.31)and 2.17(1.33-3.53),2.62(1.08-6.36),7.24(1.96-26.76),respectively.Conclusion: Through the comparison of two groups of patients,preliminarily determines the POD of independent risk factors have ASCP time,irritability and acute kidney injury classification.The results for the prognosis of patients with type A aortic dissection POD provides A theoretical basis for the establishment of treatment.Chapter 2 :Biomarkers of acute kidney injury after type A aortic dissectionObjective: Through this study,we determined that Secretory Leucocyte Protease Inhibitor(SLPI)in serum can be used as a predictive biomarker for the occurrence of AKI after type A aortic dissection.Methods: A prospective study was performed in 175 patients with type A aortic dissection in cardiothoracic Department of our hospital.Serum samples were collected 1 day before surgery,when entering ICU ward and 12,24,48 and 72 hours after operation.The samples were centrifuged at 3000 rpm for 10 minutes,then the supernatant was transferred to a cryovia and stored in a-80℃ refrigerator.Serum SLPI level was detected by ELISA.Multivariate logistic regression analysis was used to analyze the correlation between AKI and gender,chronic kidney disease,coronary heart disease,diabetes,hypertension,SLPI and other indicators.Results: In this study,the age,gender,weight,smoking rate,complications and other indicators of AKI and non AKI patients in type A aortic dissection surgery were statistically analyzed.The results showed that the clinical data of the two groups had no statistical difference,and the two groups were comparable.Multivariate logistic regression analysis showed that gender,chronic kidney disease,coronary heart disease,diabetes,hypertension and other independent variables were not related to AKI,P > 0.05,no statistical significance.There was a significant correlation between SLPI level and AKI after 12 hours in ICU,OR=1.05,95%CI =1.00-1.10,P=0.004,the difference was statistically significant.The optimal cut-off value of SLPI was 53.27ng/ml at 12 h after admission to ICU,sensitivity 75.22 %,95%CI=49.10-91.90,specificity 86.37%,95%CI=60.80-96.50,area under curve(AUC)=0.88,95% CI=0.60–0.96.The optimal cut-off value of SLPI was55.87ng/ml at 24 h after admission to ICU,sensitivity 74.77%,95%CI=46.50–90.80%,specificity 70.95%,95% CI=40.20–90.90% AUC=0.69,95%CI=0.48–0.98.The results showed that the increase of SLPI after operation indicated that the possibility of developing AKI in TAAD patients was increased.Conclusion: The study shows that serum SLPI is a biomarker of AKI after TAAA repair,and it has a high diagnostic accuracy for patients with early AKI.