Effect of early postoperative systemic inflammatory response syndrome (SIRS) on the short-term outcome of patients with acute Stanford type A aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZENG Bing , BAI Songjie , LIU Donglian , GAO Qi ,  HUANG Zhiyong

Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, 518000, Guangdong, P.R.China;

Corresponding author：

HUANG Zhiyong, Email: huzhyg@gmail.com

Keywords：

Systemic inflammatory response syndrome; acute Stanford type A aortic dissection; prognosis; surgery

DOI：

10.7507/1007-4848.202006060

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Objective To investigate the effect of early postoperative systemic inflammatory response syndrome (SIRS) on the short-term outcome of patients with acute Stanford type A aortic dissection (ATAAD).Methods The clinical data of 88 patients with ATAAD who were treated in our hospital from January 2018 to January 2020 were retrospectively analyzed. Patients were divided into a SIRS group (n=37) and a non-SIRS group (n=51) according to whether SIRS occurred within 24 hours after surgery. The perioperative data of the two groups were compared.Results There was no significant difference between the two groups in general clinical data, preoperative left ventricular ejection fraction, white blood cell (WBC) and body temperature (P>0.05). Compared with the non-SIRS group, the cardiopulmonary bypass time in the SIRS group was significantly longer (P<0.05), and the WBC and body temperature within 1 day after surgery in the SIRS group were higher (P<0.01). A significant difference was revealed in the mechanical ventilation time, ICU stay, total hospitalization time and hospitalization costs between two groups (P<0.01). Patients in the SIRS group had higher postoperative acute physiology and chronic health evaluationⅡscores, sequential organ failure assessment score as well as a greater risk of developing postoperative acute lung injury, acute kidney injury, continuous renal replacement therapy, delirium, liver dysfunction and morbidity (P<0.05).Conclusion Early postoperative SIRS significantly increases the incidence of major adverse complications and the mortality rate of patients with ATAAD.

Citation： ZENG Bing, BAI Songjie, LIU Donglian, GAO Qi, HUANG Zhiyong. Effect of early postoperative systemic inflammatory response syndrome (SIRS) on the short-term outcome of patients with acute Stanford type A aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(7): 796-800. doi: 10.7507/1007-4848.202006060 Copy

1.	中国心胸血管麻醉学会心血管麻醉分会. Stanford A 型主动脉夹层外科手术麻醉中国专家临床路径管理共识. 临床麻醉学杂志, 2018, 34(10): 1009-1013.
2.	孙立忠. 急性 A 型主动脉夹层的外科治疗. 心血管外科杂志(电子版), 2014, 3(3): 105-108.
3.	Li J, Yang L, Wang G, et al. Severe systemic inflammatory response syndrome in patients following total aortic arch replacement with deep hypothermic circulatory arrest. J Cardiothorac Surg, 2019, 14(1): 217-228.
4.	MacCallum NS, Finney SJ, Gordon SE, et al. Modified criteria for the systemic inflammatory response syndrome improves their utility following cardiac surgery. Chest, 2014, 145(6): 1197-1203.
5.	Bronicki RA, Hall M. Cardiopulmonary bypass-induced inflammatory response: Pathophysiology and treatment. Pediatr Crit Care Med, 2016, 17(8 Suppl 1): S272-S278.
6.	Gudbjartsson T, Ahlsson A, Geirsson A, et al. Acute type A aortic dissection - a review. Scand Cardiovasc J, 2020, 54(1): 1-13.
7.	沈嘉渝, 张尔永, 胡佳. 体外循环急性肺损伤与肺保护策略的研究进展. 中国胸心血管外科临床杂志, 2019, 26(2): 186-191.
8.	Zierer A, Moon MR, Melby SJ, et al. Impact of perfusion strategy on neurologic recovery in acute type A aortic dissection. Ann Thorac Surg, 2007, 83(6): 2122-2128.
9.	Shi Q, Mu X, Zhang C, et al. Risk Factors for postoperative delirium in type A aortic dissection patients: A retrospective study. Med Sci Monit, 2019, 25: 3692-3699.
10.	Marchiori PE, Lino AM, Hirata MT, et al. Occurrence of nervous system involvement in SIRS. J Neurol Sci, 2006, 250(1-2): 147-152.
11.	Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA Score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA, 2017, 317(3): 290-300.
12.	Yalçın M, Gödekmerdan E, Tayfur K, et al. The APACHEⅡscore as a predictor of mortality after open heart surgery. Turk J Anaesthesiol Reanim, 2019, 47(1): 41-47.
13.	Badreldin AM, Doerr F, Ismail MM, et al. Comparison between Sequential Organ Failure Assessment score (SOFA) and Cardiac Surgery Score (CASUS) for mortality prediction after cardiac surgery. Thorac Cardiovasc Surg, 2012, 60(1): 35-42.
14.	Zhang Y, Luo H, Wang H, et al. Validation of prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among cardiac-, thoracic-, and vascular-surgery patients admitted to a cardiothoracic intensive care unit. J Card Surg, 2020, 35(1): 118-127.
15.	Marshall JC. SIRS and MODS: What is their relevance to the science and practice of intensive care? Shock, 2000, 14(6): 586-589.
16.	Honore PM, Jacobs R, Joannes-Boyau O, et al. Newly designed CRRT membranes for sepsis and SIRS-a pragmatic approach for bedside intensivists summarizing the more recent advances: A systematic structured review. ASAIO J, 2013, 59(2): 99-106.
17.	Ng KT, Van Paassen J, Langan C, et al. The efficacy and safety of prophylactic corticosteroids for the prevention of adverse outcomes in patients undergoing heart surgery using cardiopulmonary bypass: A systematic review and meta-analysis of randomized controlled trials. Eur J Cardiothorac Surg, 2020, 57(4): 620-627.
18.	徐钰, 李佳, 曹宝平, 等. 早期使用 β 受体阻滞剂治疗肺部感染全身炎症反应综合征预后分析. 中国实用内科杂志, 2014, 34(3): 292-294.
19.	Jo Y, Anzai T, Sugano Y, et al. Early use of beta-blockers attenuates systemic inflammatory response and lung oxygenation impairment after distal type acute aortic dissection. Heart Vessels, 2008, 23(5): 334-340.
20.	Gu J, Hu J, Qian H, et al. Intestinal barrier dysfunction: A novel therapeutic target for inflammatory response in acute Stanford type A aortic dissection. J Cardiovasc Pharmacol Ther, 2016, 21(1): 64-69.

1. 中国心胸血管麻醉学会心血管麻醉分会. Stanford A 型主动脉夹层外科手术麻醉中国专家临床路径管理共识. 临床麻醉学杂志, 2018, 34(10): 1009-1013.
2. 孙立忠. 急性 A 型主动脉夹层的外科治疗. 心血管外科杂志(电子版), 2014, 3(3): 105-108.
3. Li J, Yang L, Wang G, et al. Severe systemic inflammatory response syndrome in patients following total aortic arch replacement with deep hypothermic circulatory arrest. J Cardiothorac Surg, 2019, 14(1): 217-228.
4. MacCallum NS, Finney SJ, Gordon SE, et al. Modified criteria for the systemic inflammatory response syndrome improves their utility following cardiac surgery. Chest, 2014, 145(6): 1197-1203.
5. Bronicki RA, Hall M. Cardiopulmonary bypass-induced inflammatory response: Pathophysiology and treatment. Pediatr Crit Care Med, 2016, 17(8 Suppl 1): S272-S278.
6. Gudbjartsson T, Ahlsson A, Geirsson A, et al. Acute type A aortic dissection - a review. Scand Cardiovasc J, 2020, 54(1): 1-13.
7. 沈嘉渝, 张尔永, 胡佳. 体外循环急性肺损伤与肺保护策略的研究进展. 中国胸心血管外科临床杂志, 2019, 26(2): 186-191.
8. Zierer A, Moon MR, Melby SJ, et al. Impact of perfusion strategy on neurologic recovery in acute type A aortic dissection. Ann Thorac Surg, 2007, 83(6): 2122-2128.
9. Shi Q, Mu X, Zhang C, et al. Risk Factors for postoperative delirium in type A aortic dissection patients: A retrospective study. Med Sci Monit, 2019, 25: 3692-3699.
10. Marchiori PE, Lino AM, Hirata MT, et al. Occurrence of nervous system involvement in SIRS. J Neurol Sci, 2006, 250(1-2): 147-152.
11. Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA Score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA, 2017, 317(3): 290-300.
12. Yalçın M, Gödekmerdan E, Tayfur K, et al. The APACHEⅡscore as a predictor of mortality after open heart surgery. Turk J Anaesthesiol Reanim, 2019, 47(1): 41-47.
13. Badreldin AM, Doerr F, Ismail MM, et al. Comparison between Sequential Organ Failure Assessment score (SOFA) and Cardiac Surgery Score (CASUS) for mortality prediction after cardiac surgery. Thorac Cardiovasc Surg, 2012, 60(1): 35-42.
14. Zhang Y, Luo H, Wang H, et al. Validation of prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among cardiac-, thoracic-, and vascular-surgery patients admitted to a cardiothoracic intensive care unit. J Card Surg, 2020, 35(1): 118-127.
15. Marshall JC. SIRS and MODS: What is their relevance to the science and practice of intensive care? Shock, 2000, 14(6): 586-589.
16. Honore PM, Jacobs R, Joannes-Boyau O, et al. Newly designed CRRT membranes for sepsis and SIRS-a pragmatic approach for bedside intensivists summarizing the more recent advances: A systematic structured review. ASAIO J, 2013, 59(2): 99-106.
17. Ng KT, Van Paassen J, Langan C, et al. The efficacy and safety of prophylactic corticosteroids for the prevention of adverse outcomes in patients undergoing heart surgery using cardiopulmonary bypass: A systematic review and meta-analysis of randomized controlled trials. Eur J Cardiothorac Surg, 2020, 57(4): 620-627.
18. 徐钰, 李佳, 曹宝平, 等. 早期使用 β 受体阻滞剂治疗肺部感染全身炎症反应综合征预后分析. 中国实用内科杂志, 2014, 34(3): 292-294.
19. Jo Y, Anzai T, Sugano Y, et al. Early use of beta-blockers attenuates systemic inflammatory response and lung oxygenation impairment after distal type acute aortic dissection. Heart Vessels, 2008, 23(5): 334-340.
20. Gu J, Hu J, Qian H, et al. Intestinal barrier dysfunction: A novel therapeutic target for inflammatory response in acute Stanford type A aortic dissection. J Cardiovasc Pharmacol Ther, 2016, 21(1): 64-69.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of early postoperative systemic inflammatory response syndrome (SIRS) on the short-term outcome of patients with acute Stanford type A aortic dissection

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