Influence of Impaired Hydration Status on Postoperative in-Hospital Death in Patients with Acute Type A Aortic Dissection

Figures & data

Table 1 Baseline Clinical Data of Patients with A AAD at Admission

Variables	Total (n=299)	Hydration Status (Serum Osmolality)		P
		Euhydration: 275–295 (n=168)	Impending and Current Dehydration: >295 (n=131)
Demographic characteristics
Age (y), median (IQR)	54.0 (44.0, 62.0)	52.0 (42.0, 62.0)	55.0 (47.0, 62.0)	0.105
Male, n (%)	221 (73.9)	125 (74.4)	96 (73.3)	0.826
BMI (kg/m2), median (IQR)	24.9 (24.2, 27.3)	24.8 (24.3, 27.2)	24.9 (24.1, 27.4)	0.470
Past medical history, n (%)
Hypertension, n (%)	198 (66.2)	115 (68.5)	83 (63.4)	0.356
Diabetes mellitus, n (%)	12 (4.0)	4 (2.4)	8 (6.1)	0.103
Smoker, n (%)	136 (45.5)	81 (48.2)	55 (42.0)	0.283
Drinker, n (%)	93 (31.1)	56 (33.3)	37 (28.2)	0.346
Vital signs on admission
Postoperative LVEF (%), median (IQR)	62.9 (60.2, 66.3)	63.0 (60.2, 67.2)	62.9 (60.1, 65.8)	0.378
HR, mean (SD)	80.0 (68.0, 89.0)	80.0 (70.0, 90.0)	78.0 (65.0, 88.0)	0.204
Systolic BP (mm/Hg), median (IQR)	140.0 (120.0, 158.0)	141.0 (121.3, 163.3)	136.0 (118.0, 156.0)	0.191
Diastolic BP (mm/Hg), median (IQR)	75.0 (64.0, 85.0)	75.0 (67.0, 86.0)	75.0 (62.0, 85.0)	0.466
PP (mm/Hg), median (IQR)	62.0 (49.0, 78.0)	64.0 (49.3, 80.0)	60.0 (48.0, 78.0)	0.342
Serum osmolality (mmol/L), median (IQR)	294.3 (290.6, 298.0)	291.0 (287.9, 293.0)	299.0 (296.4, 301.7)	<0.001*

Note: *Significant difference at P value < 0.05.

Abbreviations: BMI, body mass index; BP, blood pressure; PP, pulse pressure; LEVF, left ventricular ejection fraction; HR, heart rate; SD, standard deviation; IQR, interquartile range.

Figure 1 Patient flow chart of the cohort.

Abbreviation: A AAD, Acute type A aortic dissection.

Table 2 Preoperative Laboratory Test Data of the Patients Grouped by Hydration Status

Variables	Total (n=299)	Hydration Status (Serum Osmolality)		P
		Euhydration: 275–295 (n=168)	Impending and Current Dehydration: >295 (n=131)
WBC (×10^9/L), median (IQR)	12.4 (9.6, 15.2)	11.7 (9.0, 14.5)	13.4 (10.7, 16.1)	0.001*
Neutrophil (×10^9/L), median (IQR)	11.0 (8.1, 13.9)	10.0 (7.3, 13.1)	12.3 (9.7, 14.9)	0.000*
Hb (g/L), median (IQR)	133.0 (121.0, 144.0)	132.0 (120.0, 144.0)	133.0 (121.0, 142.0)	0.635
PLT (×10^9/L), median (IQR)	180.0 (145.0, 228.0)	193.5 (152.5, 237.8)	171.0 (131.0, 209.0)	0.001*
Albumin (g/L), median (IQR)	38.8 (35.8, 41.2)	38.8 (35.6, 41.2)	38.8 (36.4, 41.3)	0.812
SCr (umol/L), median (IQR)	90.0 (66.0, 116.0)	77.0 (59.0, 104.5)	103.0 (76.0, 131.0)	0.000*
Lac (mmol/L), median (IQR)	5.3 (3.1, 6.5)	5.3 (2.6, 6.5)	5.3 (3.3, 6.5)	0.227
Blood glucose (mmol/L), median (IQR)	7.1 (5.3, 7.7)	6.6 (5.3, 7.1)	7.1 (5.7, 8.2)	0.001*

Note: *Significant difference at P value < 0.05.

Abbreviations: WBC, white blood cell; Hb, hemoglobin; PLT, platelet; SD, standard deviation; IQR, interquartile range; SCr, serum creatinine; Lac, lactic acid.

Table 3 The Clinical Data of Intraoperative Patients Were Grouped by Hydration Status

Variables	Total (n=299)	Hydration Status (Serum Osmolality)		P
		Euhydration: 275–295 (n=168)	Impending and Current Dehydration: >295 (n=131)
Operating time (min), median (IQR)	297.0 (262.0, 355.0)	295.0 (265.0, 346.5)	303.0 (260.0–365.0)	0.540
CPB time (min), median (IQR)	141.0 (118.0, 176.0)	140.0 (118.0, 176.0)	144.0 (119.0, 176.0)	0.743
Crossclamp time (min), median (IQR)	62.0 (46.0, 93.0)	61.5 (45.3, 98.0)	62.0 (46.0, 89.0)	0.790
Duration of MV (h), median (IQR)	42.0 (21.0, 91.2)	36.6 (18.5, 75.8)	58.2 (30.0, 109.5)	0.002*

Note: *Significant difference at P value < 0.05.

Abbreviations: CPB, cardiopulmonary bypass; MV, mechanical ventilation.

Table 4 In-Hosiptal Outcomes After a AAD Surgery Were Grouped by Hydration Status

Variables	Total (n=299)	Hydration Status (Serum Osmolality)		P
		Euhydration: 275–295 (n=168)	Impending and Current Dehydration: >295 (n=131)
Acute renal insufficiency, n (%)	61 (20.4)	26 (15.5)	35 (26.7)	0.017*
Acute liver insufficiency, n (%)	48 (16.1)	27 (16.1)	21 (16.0)	0.992
All acute dissection rupture, n (%)	2 (0.7)	—	2 (1.5)	0.410
Gastrointestinal hemorrhage, n (%)	16 (5.4)	7 (4.2)	9 (6.9)	0.303
MODS, n (%)	6 (2.0)	2 (1.2)	4 (3.1)	0.191
In-hospital mortality, n (%)	55 (18.4)	20 (11.9)	35 (26.7)	0.001*
ICU stays (d), median (IQR)	4.9 (2.9, 7.8)	4.3 (2.8, 6.8)	5.5 (3.3, 8.8)	0.008*

Note: *Significant difference at P value < 0.05.

Abbreviations: MODS, multiple organ dysfunction syndrome; ICU, intensive care unit; IQR, interquartile range.

Figure 2 The violin plots for hydration status grouping in survivors group and non-survivors group.

Note: Significant difference at P value < 0.05.

Table 5 Determine the Factors Affecting in-Hospital Mortality by Univariate and Multivariate Logistic Regression Analysis

Independent Variables	Univariate Analysis			Multivariate Analysis
	OR	95% CI	P	OR	95% CI	P
Dehydration: >295 (mmol/L)	2.698	1.471–4.948	0.001*	3.608	1.614–8.064	0.002*
Serum albumin (g/L)	0.888	0.833–0.947	<0.001*	0.920	0.850–0.996	0.040*
CRRT (n)	1.031	1.005–1.057	0.019*	10.546	3.586–31.008	<0.001*
Drinkers (n)	1.114	1.058–1.312	0.025*	0.883	0.353–2.206	0.789
Lac (mmol/L)	1.310	1.212–1.416	0.004*	1.248	1.127–1.382	<0.001*
CAD (n)	0.974	0.959–0.990	0.001*	5.272	1.121–24.802	0.035*
Preoperative LEVF (%)	0.958	0.918–1.001	0.053	0.972	0.917–1.030	0.330

Note: *Significant difference at P value < 0.05.

Abbreviations: OR, odds ratio; CI, confidence interval; CRRT, continuous renal replacement therapy; Lac, lactic acid; CAD, coronary artery disease; LEVF, left ventricular ejection fraction.