Effect of pre-operative hypoxemia on the occurrence and outcomes of post-operative ARDS in Stanford type a aortic dissection patients.

BACKGROUND: Pre-operative and post-operative hypoxemia are frequent complications of Stanford type A aortic dissection (AAD). This study explored the effect of pre-operative hypoxemia on the occurrence and outcome of post-operative acute respiratory distress syndrome (ARDS) in AAD. METHOD: A total of 238 patients who underwent surgical treatment for AAD between 2016 and 2021 were enrolled. Logistic regression analysis was conducted to investigate the effect of pre-operative hypoxemia on post-operative simple hypoxemia and ARDS. Post-operative ARDS patients were divided into pre-operative normal oxygenation group and pre-operative hypoxemia group that were compared for clinical outcomes. Post-operative ARDS patients with pre-operative normal oxygenation were classified as the real ARDS group. Post-operative ARDS patients with pre-operative hypoxemia, post-operative simple hypoxemia, and post-operative normal oxygenation were classified as the non-ARDS group. Outcomes of real ARDS and non-ARDS groups were compared. RESULT: Logistic regression analysis showed that pre-operative hypoxemia was positively associated with the risk of post-operative simple hypoxemia (odds ratios (OR) = 4.81, 95% confidence interval (CI): 1.67-13.81) and post-operative ARDS (OR = 8.514, 95% CI: 2.64-27.47) after adjusting for the confounders. The post-operative ARDS with pre-operative normal oxygenation group had significantly higher lactate, APACHEII score and longer mechanical ventilation time than the post-operative ARDS with pre-operative hypoxemia group (P < 0.05). Pre-operative the risk of death within 30 days after discharge was slightly higher in ARDS patients with pre-operative normal oxygenation than in ARDS patients with pre-operative hypoxemia, but there was no statistical difference(log-rank test, P = 0.051). The incidence of AKI and cerebral infarction, lactate, APACHEII score, mechanical ventilation time, intensive care unit and post-operative hospital stay, and mortality with 30 days after discharge were significantly higher in the real ARDS group than in the non-ARDS group (P < 0.05). After adjusting for confounding factors in the Cox survival analysis, the risk of death within 30 days after discharge was significantly higher in the real ARDS group than in the non-ARDS group (hazard ratio(HR): 4.633, 95% CI: 1.012-21.202, P < 0.05). CONCLUSION: Preoperative hypoxemia is an independent risk factor for post-operative simple hypoxemia and ARDS. Post-operative ARDS with pre-operative normal oxygenation was the real ARDS, which was more severe and associated with a higher risk of death after surgery.

Analysis of plasma miR-208a and miR-370 expression levels for early diagnosis of coronary artery disease.

Coronary artery disease (CAD) requires more accurate diagnostic methods, for which circulating microRNAs (miRNAs) are promising non-invasive biomarkers. miR-208a and miR-370 are two key molecules in cardiac hemostasis and lipid metabolism, respectively. The aim of the present study was to evaluate their potency as diagnostic biomarkers for CAD. Plasma miR-208a and miR-370 were quantitated by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) using a TaqMan® MicroRNA Reverse Transcription and PCR kit in 95 CAD patients and 50 non-CAD control subjects. The association between the miRNA levels and CAD was analyzed statistically. The plasma levels of miR-208a (P=0.006) and miR-370 (P=0.003) were significantly higher in the CAD group than in the control group. Using receiver operating characteristic analysis it was shown that the area under the curve (AUC) of miR-208a and miR-370 was 0.819 and 0.745, respectively. The combination of miR-208a and miR-370 exhibited the largest AUC of 0.856. Thus, miR-208a and miR-370 are promising diagnostic biomarkers for discriminating CAD and may facilitate the management of patient care. The combination of the two miRNAs may be more efficacious than either miRNA alone for the diagnosis of CAD.