Risk Factors Analysis Of Postoperative Infection In Patients With Acute Stanford Type Aaortic Dissection And The Predictive Value Of Procalcitonin For Postoperative Infection In Such Patients

Objective:To analyze the risk factors of postoperative infection in patients with acute Stanford type A aortic dissection and the predictive value of procalcitonin for postoperative infection in such patients.Methods:The clinical data of 104 patients with acute Stanford type A aortic dissection admitted to Fuwai Hospital Chinese Academy of Medical Sciences,Shenzhen,from June 2017 to December 2019 were retrospectively analyzed.According to the"Hospital Infection Diagnostic Criteria"to determine whether patients had postoperative bacterial infections,they were divided into infection group(n=69)and non-infection group(n=35).According to whether septic shock occurred after surgery,the infection group were divided into the septic shock group(n=9)and non-septic shock group(n=60).According to the culture results,patients with positive bacterial culture were divided into Gram-positive bacteria group(n=12)and Gram-negative bacteria group(n=18).Preoperative data,intraoperative conditions,postoperative complications,and perioperative inflammation indexes were compared between the two groups.The risk factors of postoperative infection were analyzed by Logistic regression,and the predictive value of each inflammatory index to postoperative infection was analyzed by the receiver operating characteristic curve(ROC).Results:There were no significant differences in gender,age,weight,hypertension,diabetes and smoking history between the two groups(P>0.05).Compared with the non-infection group,cardiopulmonary bypass time,aortic cross clamping time,and deep hypothermic circulatory arrest time were significantly longer in the infection group(P<0.05).Postoperative APACHE?score,SOFA score,mechanical ventilation time,ICU hospitalization time,antibiotic application time,total hospitalization time and hospitalization costs increased significantly in the infection group(P<0.01).The incidence of acute lung injury,acute renal injury,continuous renal replacement therapy,systemic inflammatory response syndrome,delirium,liver dysfunction and hypotension increased significantly in the infection group(P<0.01).Logistic regression analysis showed that ICU hospital stay(OR=1.503,95%CI 1.013~2.230,P=0.043)and SIRS(OR=11.635,95%CI1.515~89.336,P=0.018)were the independent risk factors for postoperative infection in patients with acute Stanford A aortic dissection.ROC curve analysis showed that the critical value of ICU hospital stay was 7.5 d and the area under the curve(AUC)was 0.865(P<0.01).There was no significant difference in interleukin-6(IL-6)and hs-CRP between the two groups.The temperature,WBC and PCT in the infection group were significantly higher than the non-infection group(P<0.05).The AUC for WBC predictive of postoperative infections at 1 d,3 d,and5 d after surgery were 0.681,0.676,and 0.653,with sensitivity of 84.1%,59.4%,and 50.7%,and specificity of 45.7%,71.4%,and 80.0%,respectively.with the critical values of 9.505×10~9/L,13.285×10~9/L,and13.39×10~9/L,respectively.The AUC for PCT diagnosis of postoperative infections at 1 d,3 d,and 5 d after surgery were 0.862,0.876,and 0.863,the sensitivity was 80.6%,88.7%,and 77.4%,and the specificity was90.6%,78.1%,and 90.6%,with the critical values of 3.705 ng/ml,1.62ng/ml,and 0.561 ng/ml.The diagnostic efficiency of PCT was higher than that of WBC.Compared with the non-infective shock group,PCT in the septic shock group increased significantly before operation(P<0.05),and PCT in the three and five days after operation increased significantly(P<0.01).Compared with the Gram-negative bacteria group,the WBC of the Gram-positive bacteria group was higher before surgery(P<0.05),and there was no significant difference between the two groups in PCT and hs-CRP during perioperative period(P>0.05).Conclusion:ICU hospital stay>7.5d and postoperative SIRs were independent risk factors for postoperative infection in patients with acute Stanford type A aortic dissection.Compared with WBC,IL-6 and hs-CRP,PCT has a better predictive value for postoperative infection in patients with acute Stanford A aortic dissection.However,its critical value,sensitivity and specificity have changed.Serum PCT concentration is positively correlated with the severity of the infection,but it cannot effectively identify the species of infection.