| Objectives To investigate the influence of admission serum sodium and admission serum glucose on the short-term prognosis of patients with acute aortic dissection(AAD).Methods The clinical data of AAD patients who underwent cardiac surgery in the Fourth Hospital of Hebei Medical University from January 2015 to August 2020 were collected.The observation end points were defined as the occurrence of adverse outcomes such as postoperative in-hospital death or postoperative complications.According to the quartile of admission serum sodium,the clinical data of the four groups of AAD patients were compared.The patients with admission serum glucose >7.8mmol/L were regarded as hyperglycemia group,and the patients with admission serum glucose ≤7.8mmol/L were regarded as normal glucose group.The clinical data of the two groups of AAD patients were compared.Unconditional logistic regression was used to analyze whether admission serum sodium and admission serum glucose were the risk factors of postoperative hospital death.Conditional logistic regression was used to analyze the influence of admission serum sodium and admission serum glucose on postoperative hospital death;In order to control confounding factors,1:1 propensity score matching(PSM)was used to compare the differences.In addition,according to whether there were adverse outcomes,unconditional logistic regression analysis was used to analyze whether admission serum sodium and admission serum glucose were the risk factors of postoperative adverse outcomes,and conditional logistic regression analysis was used to analyze whether admission serum sodium and admission serum glucose were the influence of postoperative adverse outcomes;the differences were also compared using 1:1 PSM.Results 1 A total of 505 AAD patients were enrolled.According to the median and interquartile distance of admission serum sodium value,the patients were divided into four groups: 134 patients were Q1(≤136mmol/L)group,119 patients were Q2(137～138mmol/L)group,126 patients were Q3(139～140mmol/L)group,126 patients were Q4(≥141mmol/L)group.The number of in-hospital death after operation was different in the four groups(P = 0.007),there were 9 patients(6.71%)dead in group Q1,12 patients(10.08%)dead in group Q2,23 patients(18.25%)dead in group Q3 and 24patients(19.84%)dead in group Q4.Similarly,the incidence of postoperative adverse outcomes was significant difference among the groups,and increased from Q1 to Q4(from14.18% to 32.54%,P=0.001).2 According to the admission serum glucose value,the patients were divided into two groups,330 cases were normal glucose group(≤7.8mmol/L),175 cases were hyperglycemia group(>7.8mmol/L),there was a significant difference in the postoperative in-hospital mortality between the two groups(10.61% vs.18.86%,P=0.010).Similarly,the incidence of adverse events in the normal serum glucose group was lower than that in the hyperglycemia group(18.48% vs.30.29%,P=0.003).3 The inhospital death was used as a group variable,and 1:1 PSM was performed,and 61 pairs of matched successfully.Logistic regression analysis showed that high serum sodium,admission hyperglycemia,Stanford type A and systolic blood pressure were the related factors for in-hospital death.In the conditional logistic regression analysis after PSM,the risk of in-hospital death was 3.466(95%CI: 1.144-10.503,P=0.028)fold in Q3 group and3.724(95%CI: 1.185-11.704,P=0.024)fold in Q4 group with reference to Q1 group,but no difference in Q2 group;the risk of in-hospital death was 3.143(95%CI: 1.343-7.357,P=0.008)fold in hyperglycemia group with reference to normal glucose group.4 The prognosis at discharge was taken as a grouping variable,and a total of 86 pairs were matched successfully by 1:1 PSM.Logistic regression analysis before PSM showed that admission high serum sodium level,admission hyperglycemia,Stanford type A and serum calcium were the related factors of postoperative adverse outcomes within AAD patients.In the conditional logistic regression analysis after PSM,the risk of adverse prognosis was2.441(95%CI: 1.029-5.790,P=0.043)fold in Q3 group and 2.781(95%CI: 1.099-7.035,P=0.031)fold in Q4 group with reference to Q1 group,and there was no difference between Q2 group and Q1 group(P=0.553);the risk of adverse prognosis was 2.000(95%CI: 1.028-3.892,P=0.041)fold in hyperglycemia group with reference to normal glucose group。Conclusions 1 High serum sodium level and hyperglycemia on admission will increase the short-term adverse prognosis of AAD patients.2 High serum sodium and admission hyperglycemia were independent risk factors for in-hospital death 3 Admission high serum sodium level and admission hyperglycemia were the independent risk factors for the adverse outcome of AAD patients.Figure5;Table23;Reference 131... |
PDF Full Text Request