Analysis Of The Predictive Value Of Novel Coagulation Markers For Adverse Events After Acute Stanford Type A Aortic Dissection

Objective: Coagulation and fibrinolysis disorder resulting from malperfusion syndrome caused by acute aortic dissection have complex mechanisms,associated with a variety of poor postoperative outcomes which cannot be elucidated by classical coagulation laboratory tests.This study investigates whether preoperative novel coagulation laboratory tests,compared with classical coagulation laboratory tests,have predictive value for adverse events occurring after undergoing surgical intervention for acute Stanford type A aortic dissection.Methods: Patients with acute type A aortic dissection who underwent ascending aortic replacement,aortic arch replacement,and descending aortic stent implantation between January 2022 and December 2022 at the First Hospital of Chinese Medical University were enrolled and retrospectively analyzed.Patients were divided into adverse event and non adverse event groups according to whether they experienced adverse events after surgery;according to the post-operative pericardial sternal drainage volume of the patients after operation,> 1000 ml was counted into the bleeding group,and the remaining entered non bleeding group;patients were divided into CRRT group and non CRRT group according to whether they were treated with CRRT after surgery;according to the patients’ postoperative ventilator time,> 48 h was set as the prolong group,and the rest are the non prolong group.Univariate analysis of the patients’ basic conditions on admission,preoperative classical coagulation laboratory tests,novel coagulation tests and perioperative blood products transfusion was performed to screen the influencing indicators related to the occurrence of postoperative adverse events.The independent risk factors for the occurrence of postoperative adverse events were analyzed using logistic regression,ROC curves were drawn to determine the cut-off values of relevant sensitive indicators,and the correlation between relevant indicators and the occurrence of adverse events was compared.Results: Postoperative-related adverse events(drainage >1000 ml,ventilator time >48hours,CRRT application,myocardial infarction,stroke or transient ischemic attack,distal limb gangrene,and in-hospital death)were observed in 52 of 80 patients(65%).Among the preoperative novel coagulation assays,protein s was measured(89.34±14.93% vs 102.74±20.60,P=0.004),thrombin-antithrombin complex(28.90±23.67ng/m L vs 15.95±9.86,P=0.001),tissue fibrinogen activator-fibrinogen activator inhibitor-1 complex(11.45±8.80ng/m L vs 6.26±2.68,P<0.001),and plasma thrombomodulin(9.95±3.81TU/m L vs 6.29±0.60,P<0.001)were significantly different between the two groups.Logistic analysis showed that thrombomodulin(OR=4.150,95%CI:0.917～18.781,P=0.005)was an independent risk factor for adverse events after surgery in patients with acute aortic coarctation,with an AUC of 0.879 and a cut-off value of 7.4 TU/m L,P<0.001,which had predictive value for adverse events.Sixteen(20%)cases with pericardial retrosternal drainage >1000m L at 24 h postoperatively and indicators found to be statistically different by univariate analysis were included in logistic regression analysis,which showed that thrombomodulin(OR=2.930,95% CI: 1.120 to 7.669,P=0.029)had an AUC of 0.806 and a cut-off value of 7.0 TU/ml,P<0.001,was an independent risk factor affecting the early postoperative increase in drainage in patients with acute aortic dissection,and had a good diagnostic value for early postoperative increase in drainage.Sixteen patients(20%)were treated with CRRT,and indicators found to be statistically different by univariate analysis were included in the logistic regression analysis,which showed that thrombomodulin(OR=1.266,95% CI: 1.022 to 1.567,P=0.030)AUC was0.911 with a cut-off value of 8.2 TU/ml,P<0.001.It has a good predictive value for the application of continuous renal replacement therapy at the bedside.Forty-eight patients(60%)had a postoperative ventilator time >48 h.Univariate analysis of indicators found to be statistically different were included in the logistic regression analysis,which showed an AUC of 0.792 for thrombomodulin(OR=1.285,95% CI: 1.000 to 1.625,P=0.05)with a cut-off value of 6.9 TU/ml,P<0.001,which had a good predictive value for prolonged postoperative ventilator time.Conclusion: Novel coagulation tests show a significant difference between groups whether adverse events occurred after acute type A aortic dissection.Elevated preoperative thrombomodulin predicted increased postoperative drainage,continuous renal replacement therapy and prolonged ventilator time.