Inflammatory biomarkers to predict adverse outcomes in postoperative patients with acute type A aortic dissection

Figures & data

Figure 1. Flow diagram of patient recruitment to this study.

Table 1. Demographic and characteristics of patients with ATAAD.

	All (n = 328)
Male, n (%)	243 (74)
Age (years)	51 ± 12
BMI (kg/m^2)	25 ± 3.6
Hypertension, n (%)	217 (66)
Marfan syndrome, n (%)	16 (5)
Previous cardiac/vascular surgery, n (%)	30 (9)
Malperfusion, n (%)	20 (6)
Diabetes mellitus, n (%)	16 (5)
Coronary artery disease, n (%)	10 (3)
Chronic renal dysfunction, n (%)	9 (3)
Emergency operation, n (%)	212 (65)
Surgical procedures, n (%)
Ascending aorta + arch replacement + stent implantation	193 (59)
David/Bentall/Sinus plasty + arch replacement + stent implantation	85 (26)
Ascending aorta/ David/ Bentall + arch replacement	39 (12)
Ascending replacement / David/ Bentall	11 (3)
CPB time (min)	183 ± 35
Cross-clamp time (min)	107 ± 26
DHCA time (min)	24 ± 8
Esophageal temperature (°C)	21 ± 2
Intraoperative red blood cell transfusion (u)	6 ± 3
Intraoperative plasma transfusion (ml)	720 ± 389
SOFA score	6 ± 3
APACHE II score	10 ± 6
Mechanical ventilation time (hour)	101 ± 185
LOS in ICU (day)	9 ± 11
LOS in Hospital (day)	21 ± 14

BMI: body mass index; CPB: cardiopulmonary bypass; DHCA: deep hypothermic circulatory arrest; LOS: length of stay; ICU: intensive care unit; SOFA: Sequential Organ Failure Assessment; APACHE II: Acute Physiology and Chronic Health Evaluation II

Table 2. Factors affecting inflammatory markers at T1.

	CPB time		Cross-clamp time		Red cell transfusion		Plasma transfusion
	r	p	r	p	r	p	r	p
WBC	0.062	.397	0.080	.277	−0.048	.396	−0.010	.864
CRP	0.117	.231	−0.059	.549	−0.070	.368	−0.048	.533
PCT	0.316	<.001	0.234	.002	0.228	<.001	0.199	.001
IL-2R	0.214	.013	0.117	.178	0.295	<.001	0.247	<.001
IL-6	0.044	.618	0.113	.198	−0.016	.816	0.001	.986
IL-8	0.068	.436	−0.152	.080	0.110	.111	0.064	.356
TNF-α	−0.014	.876	−0.081	.357	0.032	.648	−0.031	.658

Figure 2. Comparing levels of lgPCT, lgTNF-α, lgIL-2R, lgIL-6, lgIL-8, WBC, and CRP between survivor group and non-survivor group (*p < .05).

Figure 3. Comparing lg PCT, lg TNF-α, lg IL-2R, lg IL-6, lg IL-8, WBC, and CRP between non-AKI group, AKI stage I/II group, and AKI stage III group (*p < .05).

Table 3. Correlations among SOFA and APACHE II scores and serum concentrations of studied biomarkers in the overall group of patients.

	SOFA score				APACHE II score
	Univariate		Multivariate		Univariate		Multivariate
	r	p	B	p	r	p	B	p
WBC (10^9/L)	0.052	.353	−0.032	.566	0.037	.505	0.005	.971
PCT (ng/ml)	0.421	<.001	0.033	.135	0.405	<.001	0.114	.025
CRP (mg/l)	0.133	.078	0.002	.484	0.170	.023	0.006	.288
TNF-α (pg/ml)	0.085	.204	−0.006	.789	0.072	.286	−0.016	.743
IL-2R (U/ml)	0.434	<.001	0.001	<.001	0.456	<.001	0.003	<.001
IL-6 (pg/ml)	0.154	.022	0.009	.014	0.049	.471	0.009	.283
IL-8 (pg/ml)	0.139	.039	0.001	.820	0.172	.010	0.011	.309

Figure 4. ROC curve of the relationship between concentrations of biomarkers at T1 and mortality (A) or AKI stage III (B).

Table 4. Cutoff values of inflammatory markers, cytokines and scores to predict mortality.

Variable	AUC	95%CI	p value	Cutoff value	Specificity (%)	Sensitivity (%)	PPV (%)	NPV (%)	Youden index
PCT	0.686	0.555–0.817	.009	4.58ng/ml	66.7	62.1	65.1	63.8	0.288
TNF-α	0.592	0.457–0.726	.196	10.55pg/ml	66.7	58.9	63.9	61.9	0.256
IL-2R	0.718	0.598–0.838	.002	1438U/ml	79.2	71.1	77.4	73.2	0.503
IL-6	0.694	0.556–0.832	.006	45.5pg/ml	79.2	64.7	75.7	69.2	0.439
IL-8	0.627	0.498–0.756	.073	25.55pg/ml	66.7	57.9	63.5	61.3	0.246
SOFA	0.786	0.679–0.893	<.001	7.50	58.3	82.1	66.3	76.5	0.404
APACHE II	0.770	0.652–0.889	<.001	15.5	54.2	87.9	65.7	81.7	0.421
WBC	0.535	0.394–0.676	.621	–	–	–	–	–	–
CRP	0.535	0.395–0.676	.620	–	–	–	–	–	–

PPV: positive predictive value; NPV: negative predictive value

Table 5. Cutoff values of inflammatory markers, cytokines, and scores to predict stage III AKI.

	AUC	95%CI	p value	Cutoff value	Specificity (%)	Sensitivity (%)	PPV (%)	NPV (%)	Youden value
PCT	0.852	0.793–0.910	<.001	3.425ng/ml	78	80	86.3	79.6	0.570
TNF-α	0.636	0.544–0.728	.004	10.45pg/ml	67.6	67.1	67.4	67.2	0.347
IL-2R	0.749	0.670–0.827	<.001	1222U/ml	73	72.1	72.8	72.3	0.451
IL-6	0.588	0.497–0.680	.065	37.7pg/ml	63.5	57.1	61.0	59.7	0.206
IL-8	0.626	0.537–0.714	.009	24.25pg/ml	66.2	62.9	65.0	64.1	0.291
SOFA	0.761	0.688–0.835	<.001	5.5	75.7	64.3	72.6	68.0	0.400
APACHE II	0.772	0.696–0.849	<.001	10.5	79.7	64.3	76.0	69.1	0.440
WBC	0.507	0.408–0.607	.879	–	–	–	–	–	–
CRP	0.549	0.456–0.642	.306	–	–	–	–	–	–

PPV: positive predictive value; NPV: negative predictive value

Figure 5. ROC curve of combined score to predict mortality.

Table 6. Multivariate analysis of in-hospital mortality within 30 days.

	Univariate analysis	Multivariate analysis			Adjusted multivariate analysis*
Markers	p value	B	OR (95% CI)	p value	p value
Gender	.089	−1.020	0.361 (0.095–1.367)	.133	.061
Age	.125	0.033	1.033 (0.987–1.082)	.165	.017
PCT > 4.58ng/ml	<.001	0.554	1.741 (0.575–5.273)	.327	.247
IL-2R > 1438U/ml	<.001	1.460	4.307 (1.349–13.753)	.014	.009
IL-6 > 45.5pg/ml	<.001	2.172	8.779 (2.865–26.897)	<.001	.112
IL-8 > 25.55pg/ml	.031	0.167	1.181 (0.417–3.345)	.754	.943
SOFA score > 7.5	<.001	1.265	1.093 (1.002–12.533)	.050	.113
APACHE II score > 15.5	<.001	1.010	2.747 (0.755–9.987)	.125	.709

^* With adjustment for CPB time and intraoperative red blood cell transfusion.