Admission Systolic Blood Pressure Predicts Post-Operative Delirium of Acute Aortic Dissection Patients in the Intensive Care Unit

Figures & data

Figure 1 Flow chart of study population and groups.

Table 1 Baseline Characteristics According to Admission Systolic Blood Pressure

Characteristics	Total (n=205)	Blood Pressure (mmHg)			P-value
		≤90 (n=14)	91–139 (n=162)	≥140 (n=29)
Demographics
Gender					0.258
Male	147 (71.7%)	8 (57.1%)	120 (74.1%)	19 (65.5%)
Female	58 (28.3%)	6 (42.9%)	42 (25.9%)	10 (34.5%)
Age, years	51.0 (44.0–57.0)	50.8±15.5	50.0 (44.0–56.0)	50.6±9.0	0.589
Comorbidities
HBP	149 (72.7%)	6 (42.9%)	122 (75.3%)	21 (72.4%)	0.045
Diabetes	11 (5.4%)	0 (0.0%)	8 (4.9%)	3 (10.3%)	0.406
CAD	15 (7.3%)	2 (14.3%)	10 (6.2%)	2 (7.7%)	0.332
Valvular disease	15 (7.3%)	2 (14.3%)	10 (6.2%)	3 (10.3%)	0.332
Stroke/TIA	9 (4.4%)	1 (7.1%)	5 (3.1%)	3 (10.3%)	0.397
CKD	4 (2.0%)	0 (0.0%)	3 (1.9%)	1 (3.4%)	0.613
Marfan’s syndrome	10 (4.9%)	3 (21.4%)	6 (3.7%)	1 (3.4%)	0.031
Anemia	98 (48.0%)	9 (64.3%)	71 (44.1%)	18 (62.1%)	0.092
Physical examination
DBP	60.0 (53.0–69.0)	52.2±10.6	60.6±11.3	67.6±18.3	0.007
Mean arterial pressure	80.0 (73.0–88.7)	64.2±8.0	79.9±9.6	93.0 (85.3–104.7)	0.000
Admission laboratory values
WBC, K/uL	11.6 (8.9–14.4)	12.1±3.3	11.8 (9.3–14.1)	9.8 (7.4–15.0)	0.475
PLT, K/uL	158.0 (128.5–200.5)	165.5 (137.0–232.0)	157.0 (128.0–194.0)	170.9±64.7	0.471
Hb, g/dL	129.0 (114.0–140.5)	131.2±20.7	129.0 (114.0–141.0)	122.0 (109.0–132.0)	0.116
TB, μmol/L	14.0 (10.6–19.6)	11.4 (7.3–24.7)	14.0 (10.8–18.9)	16.5±8.9	0.482
ALT, U/L	22.5 (14.9–38.8)	21.4 (14.6–53.0)	22.8 (14.9–39.1)	21.3 (15.1–34.7)	0.979
BUN, mmol/L	6.9 (5.2–8.9)	6.7±2.6	6.9 (5.1–8.9)	6.7 (5.7–9.2)	0.673
Cr, μmol/L	104.9 (84.3–134.2)	99.0 (89.1–128.8)	105.1 (86.1–134.4)	98.0 (76.0–147.5)	0.811
UA, μmol/L	369.2 (298.3–450.0)	381.4±124.3	368.0 (300.0–446.2)	394.2±130.4	0.957
Glucose, mmol/L	7.4 (6.4–8.7)	7.0 (6.9–9.0)	7.4 (6.4–8.6)	7.9±2.4	0.817
BNP, pg/mL	472.9 (189.5–1160.5)	596.7 (109.0–1445.5)	442.0 (163.0–1133.0)	592.0 (376.0–1169.0)	0.902
PT, s	14.7 (13.7–15.8)	15.3±1.6	14.6 (13.6–15.5)	15.3±1.4	0.353
D-dimer, mg/L	1.6 (0.9–2.5)	2.0±1.1	1.6 (0.9–2.3)	1.9±1.3	0.935
cTnI, ng/mL	0.01 (0.01–0.07)	0.02 (0.01–0.08)	0.01 (0.01–0.07)	0.01 (0.01–0.05)	0.906

Note: The italic and bold formatting indicates characteristics classification.

Abbreviations: HBP, high blood pressure; CAD, coronary artery disease; CKD, chronic kidney disease; DBP, diastolic blood pressure; WBC, white blood cell; Hb, hemoglobin; PLT, platelet; ALB, albumin; TB, total bilirubin; ALT, alanine transaminase; BUN, blood urea nitrogen; Cr, creatinine; UA, uric acid; BNP, brain natriuretic peptide; PT, prothrombin time; cTnI, cardiac troponin I.

Table 2 Treatments Between SBP Groups

Variables	Total (n=205)	Blood Pressure (mmHg)			P-value
		≤90 (n=14)	91–139 (n=162)	≥140 (n=29)
Surgical procedure					0.066
Sun’s	130 (63.7%)	5 (35.7%)	108 (67.1%)	17 (58.6%)
Sun’s + root	42 (20.6%)	6 (42.9%)	30 (18.6%)	6 (20.7%)
Ascending + arch	24 (11.8%)	3 (21.4%)	15 (9.3%)	6 (20.7%)
Bentall	8 (3.9%)	0 (0.0%)	8 (5.0%)	0 (0.0%)
Operation duration, hours	7.6 (6.5–9.0)	7.7±1.4	7.5 (6.5–8.9)	8.0±2.2	0.887
Aortic cross-clamp time, min	105.0 (80.0–124.0)	122.5 (110.0–128.0)	103.0 (80.0–120.0)	115.4±44.7	0.085
Cardiopulmonary bypass time, min	187.0 (166.5–210.5)	187.7±29.3	187.0 (166.0–211.0)	199.6±45.7	0.736
Circulatory arrest time, min	25.0 (21.0–29.5)	22.7±9.8	25.0 (21.0–29.0)	26.0 (22.5–32.0)	0.281
Length of stay
Hospital stay, days	16.0 (12.0–21.5)	15.5 (11.0–21.0)	16.0 (11.5–21.0)	16.0 (12.0–25.0)	0.734
ICU stay, hours	111.8 (81.5–174.0)	120.0 (110.0–155.0)	109.5 (77.0–184.0)	128.5 (96.5–161.0)	0.444

Notes: Sun’s procedure indicates total arch replacement combined with stented elephant trunk implantation. Sun’s + root indicates Sun’s and aortic root replacement. Ascending + arch indicates ascending aorta and total arch replacement. Bentall indicates compound replacement of aortic root, aortic valve and ascending aorta, with re-insertion of coronary arteries into the new attachment or graft. ICU indicates intensive care unit. The italic and bold formatting indicates different variables.

Table 3 Outcomes Difference Between SBP Groups

Outcomes	Total (n=205)	Blood Pressure (mmHg)			P-value
		≤90 (n=14)	91–139 (n=162)	≥140 (n=29)
Delirium	36 (17.6%)	1 (7.1%)	24 (14.8%)	11 (37.9%)	0.012
30-day mortality	29 (14.1%)	2 (14.3%)	23 (14.2%)	4 (13.8%)	1.000
Acute kidney injury	28 (13.7%)	1 (7.1%)	26 (16.0%)	1 (3.4%)	0.161
Cardiac complication	22 (10.7%)	0 (0.0%)	19 (11.7%)	3 (10.3%)	0.575
Spinal cord ischemia	14 (6.8%)	3 (21.4%)	9 (5.6%)	2 (6.9%)	0.087
Postoperative Stroke	6 (2.9%)	1 (7.1%)	1 (0.6%)	4 (13.8%)	0.002
Pneumonia	29 (14.1%)	2 (14.3%)	22 (13.6%)	5 (17.2%)	0.809

Table 4 Predictors of POD on Univariate Logistic Regression and Cox Proportional Hazards Analysis

Variable	Logistic Regression		Cox Proportional Hazards
	OR (95% CI)	P value	HR (95% CI)	P value
Age	1.012 (0.977–1.047)	0.513	1.019 (0.969–1.071)	0.459
Male sex	1.225 (0.537–2.793)	0.629	0.743 (0.282–1.960)	0.743
HBP	0.972 (0.435–2.173)	0.946	1.007 (0.402–2.519)	0.989
CAD	0.706 (0.152–3.274)	0.656	1.064 (0.196–5.773)	0.942
Valvular disease	2.565 (0.820–8.022)	0.106	2.286 (0.768–6.808)	0.137
Diabetes	0.454 (0.056–3.665)	0.459	0.422 (0.054–3.319)	0.412
CKD	1.581 (0.160–15.648)	0.695	0.000 (0.000)	0.978
Stroke/TIA	0.816 (0.284–2.340)	0.705	0.756 (0.239–2.393)	0.635
Marfan’s syndrome	0.508 (0.062–4.140)	0.527	1.384 (0.140–13.632)	0.781
Anemia	0.839 (0.407–1.730)	0.635	0.920 (0.395–2.142)	0.846
Aortic cross-clamp time	1.001 (0.992–1.010)	0.877	0.989 (0.976–1.002)	0.103
CPB time	1.005 (0.999–1.010)	0.092	1.009 (1.001–1.017)	0.027
Circulatory arrest time	1.013 (0.970–1.058)	0.554	0.989 (0.976–1.002)	0.989
Postoperative ventilation duration	1.000 (0.996–1.004)	0.882	1.000 (0.996–1.003)	0.893
SBP	1.026 (1.007–1.046)	0.004	3.064 (1.311−7.158)	0.010
DBP	1.018 (0.990–1.046)	0.215	1.009 (0.980–1.039)	0.567
ALB	1.060 (0.980–1.146)	0.147	1.069 (0.978–1.169)	0.140
TB	1.026 (0.990–1.063)	0.162	1.028 (0.993–1.063)	0.115
Cr	1.001 (0.997–1.006)	0.507	1.001 (0.993–1.010)	0.747
PT	1.091 (0.976–1.219)	0.125	1.048 (0.959–1.145)	0.303
D-Dimer	1.018 (0.908–1.140)	0.761	1.038 (0.935–1.152)	0.488

Abbreviations: HBP, high blood pressure; CAD, coronary artery disease; CKD, chronic kidney disease; CPB, cardiopulmonary bypass; SBP, systolic blood pressure; DBP, diastolic blood pressure; ALB, albumin; TB, total bilirubin; Cr, creatinine; PT, prothrombin time.

Table 5 ORs (95% CIs) for Delirium Across Groups of Admission Systolic Blood Pressure

SBP (mmHg)	Non-Adjusted		Model
	OR (95% CI)	P value	OR (95% CI)	P value
≤90	0.442 (0.055–3.539)	0.442	0.621 (0.070–5.518)	0.669
91–139	1.0 (ref)	/	1.0 (ref)	/
≥140	3.514 (1.478–8.357)	0.004	4.655 (1.708–12.687)	0.003

Notes: ORs were calculated from logistic regression models. Non-adjusted model adjusted to none. Model adjusted to demographics, history of diabetes, coronary artery disease, cardiac valvular disease, Marfan’s syndrome, chronic kidney injury, cardiopulmonary bypass time, aortic cross-clamp time, hemoglobin, albumin, total bilirubin, alanine transaminase, creatinine, uric acid, and D-dimer.

Abbreviations: SBP, systolic blood pressure; OR, odds ratio; ref, reference.

Table 6 Subgroup Analysis of the Association Between Systolic Blood Pressure and Delirium

	Num of Patients	Admission Systolic Blood Pressure (mmHg)			P-value for Interaction
		≤90	91–139	≥140
Overall population	205	0.442 (0.055–3.539)	Ref	3.514 (1.478–8.357)
Age, years					0.057
<51	102	0.000 (0.000)	Ref	2.939 (0.758–11.397)
≥51	103	0.825 (0.093–7.318)	Ref	4.200 (1.320–13.367)
Gender					0.213
Male	147	0.759 (0.088–6.531)	Ref	3.101 (1.082–8.889)
Female	58	0.000 (0.000)	Ref	4.933 (1.024–23.772)
HBP					0.044
No	56	0.000 (0.000)	Ref	2.829 (0.545–14.690)
Yes	149	1.235 (0.136–11.231)	Ref	3.801 (1.372–10.529)
Anemia					0.003
No	106	0.000 (0.000)	Ref	0.889 (0.176–4.478)
Yes	99	1.354 (0.144–12.730)	Ref	10.833 (3.116–37.668)
Hyperuricemia					0.025
No	138	0.000 (0.000)	Ref	3.231 (1.057–9.879)
Yes	67	0.606 (0.066–5.578)	Ref	4.545 (1.041–19.857)
BUN, mmol/L					0.014
<7.1	107	0.948 (0.106–8.463)	Ref	2.413 (0.652–8.928)
≥7.1	97	0.000 (0.000)	Ref	4.923 (1.475–16.434)
Cr, μmol/L					0.007
<110	114	0.000 (0.000)	Ref	1.974 (0.552–7.066)
≥110	89	1.073 (0.114–10.091)	Ref	6.258 (1.764–22.199)

Notes: Anemia was diagnosed by hemoglobin cut-off level below 110 g/L for females and below 120 g/L for males. Hyperuricemia was defined as uric acid > 428.0 μmol/L in males and > 357.0 μmol/L in females. The bold formatting indicates subgroup grouping basis.

Abbreviations: BUN, blood urea nitrogen; Cr, creatinine; ref, reference.