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Objective:To analyse the effect of preoperative renal function classification on early outcomes for patients with acute type A aortic dissection(AAAD) and to estimate the risk factors of postoperative major adverse events.Methods:From January 2012 to December 2019, 226 patients with AAAD who underwent total arch replacement at our institution were retrospectively analysed, including 146 males and 80 females, aged(54.4±12.5) years old. Stages of preoperative renal function were defined as follows: Normal[estimated glomerular ltration rate(eGFR)≥90 ml·min -1·1.73 m -2, 68 cases], Mild(eGFR 60-89 ml·min -1·1.73 m -2, 73 cases); Moderate(eGFR 30-59 ml·min -1·1.73 m -2, 57 cases), Severe(eGFR<30 ml·min -1·1.73 m -2, 28 cases). The independent risk factors for postoperative death were analyzed by logistic regression analysis. The area under the receiver operating characteristic curve was used to assess the efficiency of eGFR for predicting the postoperative hemodialysis. Results:In-hospital death occurred in 24(10.6%) cases. Major complications included postoperative hemodialysis in 49(21.7%) cases, stroke in 19(8.4%) cases and tracheotomy in 15(6.6%) cases. The best cut-off value of the eGFR for predicting postoperative hemodialysis was 36.5 ml·min -1·1.73 m -2(area under the receiver operating characteristic curve was 0.793). The following variables were found to be risk factors of in-hospital mortality in multivariate logistic regression analysis: serum creatinine, eGFR<30 ml·min -1·1.73 m -2, neural malperfusion, bowel malperfusion, postoperative stroke and hemodialysis. Conclusion:Total arch replacement can be safely performed in patients with AAAD and mild renal dysfunction. Preoperative renal dysfunction is a risk factor for postoperative hemodialysis, and eGFR is useful for predicting the requirement for hemodialysis after total arch replacement. The severity of preoperative renal dysfunction could greatly influence the outcomes after total arch replacement for AAAD. More importance should be attached to the assessment of preoperative renal function during clinical risk assessment.
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Objective:To measure serum level of cystatin C (Cys C)in patients with essential hypertension (EH)and analyze its correlation with pulse pressure (PP).Methods:A total of 60 EH patients and 30 cases with normal physi-cal examination results were selected.According to PP level,EH patients were divided into PP>60mmHg group (n=29)and PP≤60mmHg group (n=31).Serum Cys C concentration was measured by latex particle-enhanced immu-noturbidimetric method in two groups,and the results were statistically analyzed.Results:Cys C level of PP >60mmHg group was significantly higher than that of PP≤60mmHg group,and the both groups were significantly higher than that of normal control group [(1.40±0.06)mg/L vs.(1.19±0.54)mg/L vs.(0.72±0.20)mg/L], P <0.05 all;linear correlation analysis indicated that Cys C level was positively correlated with PP (r =0.325,P <0.05)and systolic blood pressure (SBP,r = 0.399,P < 0.05),and PP was positively correlated with SBP (r =0.876,P <0.01)in EH group.Conclusion:Cys C level is positively correlated with PP in EH patients.Cys C level can be used as an early index detecting renal function damage caused by hypertension.
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0.05),but the integrated arthoplasty group had significant differences from the other two groups(P