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S100B predicts neurological injury and 30-day mortality following surgery for acute type A aortic dissection : an observational cohort study

Teurneau-Hermansson, Karl LU orcid ; Ede, Jacob LU orcid ; Larsson, Mårten LU ; Moseby-Knappe, Marion LU ; Bjursten, Henrik LU ; Nozohoor, Shahab LU ; Sjögren, Johan LU and Zindovic, Igor LU (2023) In Journal of Cardiothoracic Surgery 18(1).
Abstract

Background: Neurological injuries are frequent following Acute Type A Aortic Dissection (ATAAD) repair occurring in 4–30% of all patients. Our objective was to study whether S100B can predict neurological injury following ATAAD repair. Methods: This was a single-center, retrospective, observational study. The study included all patients that underwent ATAAD repair at our institution between Jan 1998 and Dec 2021 and had recorded S100B-values. The primary outcome measure was neurological injury, defined as focal neurological deficit or coma diagnosed by clinical assessment with or without radiological confirmation and with a symptom duration of more than 24 h. Secondary outcome measure was 30-day mortality. Results: 538 patients... (More)

Background: Neurological injuries are frequent following Acute Type A Aortic Dissection (ATAAD) repair occurring in 4–30% of all patients. Our objective was to study whether S100B can predict neurological injury following ATAAD repair. Methods: This was a single-center, retrospective, observational study. The study included all patients that underwent ATAAD repair at our institution between Jan 1998 and Dec 2021 and had recorded S100B-values. The primary outcome measure was neurological injury, defined as focal neurological deficit or coma diagnosed by clinical assessment with or without radiological confirmation and with a symptom duration of more than 24 h. Secondary outcome measure was 30-day mortality. Results: 538 patients underwent surgery during the study period and 393 patients, had recorded S100B-values. The patients had a mean age of 64.4 ± 11.1 years and 34% were female. Receiver operating characteristic curve for S100B 24 h postoperatively yielded area under the curve 0.687 (95% CI 0.615–0.759) and best Youden’s index corresponded to S100B 0.225 which gave a sensitivity of 60% and specificity of 75%. Multivariable logistic regression identified S100B ≥ 0.23 μg/l at 24 h as an independent predictor for neurological injury (OR 4.71, 95% CI 2.59–8.57; p < 0.01) along with preoperative cerebral malperfusion (OR 4.23, 95% CI 2.03–8.84; p < 0.01) as well as an independent predictor for 30-day mortality (OR 4.57, 95% CI 1.18–11.70; p < 0.01). Conclusions: We demonstrated that S100B, 24 h after surgery is a strong independent predictor for neurological injury and 30-day mortality after ATAAD repair. Trial registration: As this was a retrospective observational study it was not registered.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Aorta, Dissection, Neurological injury, S100B
in
Journal of Cardiothoracic Surgery
volume
18
issue
1
article number
62
publisher
BioMed Central (BMC)
external identifiers
  • pmid:36747206
  • scopus:85147460692
ISSN
1749-8090
DOI
10.1186/s13019-023-02151-2
language
English
LU publication?
yes
additional info
Funding Information: Open access funding provided by Lund University. This research has been funded by The Agreement for Medical Education and Research, Sweden and Region Skåne. Publisher Copyright: © 2023, The Author(s).
id
61a9f017-9211-42ae-87a6-9a63cc02aefe
date added to LUP
2023-02-20 08:05:56
date last changed
2024-04-18 09:12:07
@article{61a9f017-9211-42ae-87a6-9a63cc02aefe,
  abstract     = {{<p>Background: Neurological injuries are frequent following Acute Type A Aortic Dissection (ATAAD) repair occurring in 4–30% of all patients. Our objective was to study whether S100B can predict neurological injury following ATAAD repair. Methods: This was a single-center, retrospective, observational study. The study included all patients that underwent ATAAD repair at our institution between Jan 1998 and Dec 2021 and had recorded S100B-values. The primary outcome measure was neurological injury, defined as focal neurological deficit or coma diagnosed by clinical assessment with or without radiological confirmation and with a symptom duration of more than 24 h. Secondary outcome measure was 30-day mortality. Results: 538 patients underwent surgery during the study period and 393 patients, had recorded S100B-values. The patients had a mean age of 64.4 ± 11.1 years and 34% were female. Receiver operating characteristic curve for S100B 24 h postoperatively yielded area under the curve 0.687 (95% CI 0.615–0.759) and best Youden’s index corresponded to S100B 0.225 which gave a sensitivity of 60% and specificity of 75%. Multivariable logistic regression identified S100B ≥ 0.23 μg/l at 24 h as an independent predictor for neurological injury (OR 4.71, 95% CI 2.59–8.57; p &lt; 0.01) along with preoperative cerebral malperfusion (OR 4.23, 95% CI 2.03–8.84; p &lt; 0.01) as well as an independent predictor for 30-day mortality (OR 4.57, 95% CI 1.18–11.70; p &lt; 0.01). Conclusions: We demonstrated that S100B, 24 h after surgery is a strong independent predictor for neurological injury and 30-day mortality after ATAAD repair. Trial registration: As this was a retrospective observational study it was not registered.</p>}},
  author       = {{Teurneau-Hermansson, Karl and Ede, Jacob and Larsson, Mårten and Moseby-Knappe, Marion and Bjursten, Henrik and Nozohoor, Shahab and Sjögren, Johan and Zindovic, Igor}},
  issn         = {{1749-8090}},
  keywords     = {{Aorta; Dissection; Neurological injury; S100B}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Journal of Cardiothoracic Surgery}},
  title        = {{S100B predicts neurological injury and 30-day mortality following surgery for acute type A aortic dissection : an observational cohort study}},
  url          = {{http://dx.doi.org/10.1186/s13019-023-02151-2}},
  doi          = {{10.1186/s13019-023-02151-2}},
  volume       = {{18}},
  year         = {{2023}},
}