Aortic Aneurysm and Dissection, Cardiac Valve Disease, Thoracic Aortic Aneurysm, Thoracic Aortic Dissection
Conditions
Keywords
biomarkers, presepsin, complications, aortic arch, aorta, aortic aneurysm, ascending aorta, cardiac surgery
Brief summary
According to the literature, presepsin was recommended not only as an effective indicator in the diagnosis of sepsis in intensive care units, but also as a reliable prognostic marker of postoperative inflammatory processes in cardiac surgery. Previous study carried out in Petrovsky NRCS related to biomarkers in cardiac surgery and presepsin in particular showed good sensitivity in infection complications prognosis.
Detailed description
Various biomarkers are being used to improve the quality of prediction models aiming to improve clinical outcomes and reduce mortality in the cardiac surgery patient population. In particular, presepsin and procalcitonin have comparable prognostic value for adverse renal, cardiovascular and respiratory outcomes in cardiac surgery patients. In addition, presepsin has in-hospital, 30-day, and 6-month prognostic mortality rate value and is also highly effective for the early diagnosis of sepsis in patients in the intensive care unit. In the previous study the absence of an increase in the level of presepsin in the first 6 hours after surgery was associated with an increased risk of developing a complicated course of the postoperative period (OR 4.15, 95% CI: 1.83-9.41). The combination of two risk factors - a presepsin level at the end of surgery \>519.5 pg/ml and the absence of an increase in the presepsin level in the first 6 hours after surgery was associated with an increased risk of developing a complicated course of the postoperative period (OR 5.80, 95% CI: 2. 19-15.35). The hypothesis of this study suggests that in case of insufficient prevention of infectious complications, based on the dynamics of presepsin, it is permissible to administer the broad-spectrum drug ampicillin/sulbactam 3 g. every 6 hours for at least 72 hours from the date of surgery. It is expected that changes in the tactics of antibacterial therapy will reduce the number of inflammatory complications in patients undergoing surgery on thoracic aorta.
Interventions
If a patient meets dual criteria (presepsin \> 519,5 pg/ml at the end of surgery and the absence of presepsin increase after 6 hours after the end of surgery) then switching to ampicillin/sulbactam 3 g every 6 hours at least 72 h after the surgery is done.
Sponsors
Petrovsky National Research Centre of Surgery
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
Thoracic aorta aneurysm/dissection
Exclusion criteria
Blood sample hemolysis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Infectious complications rate | up to 10 days | Postoperative pneumonia, sepsis, wound infection, mediastinitis |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total amount of complicated patients | up to 10 days | Patients that suffer at least 1 complication in postoperative period |
| Mortality | up to 10 days | In-hospital mortality rate |
| Length of hospital stay | up to 10 days | Days spent in hospital since admission |
| Length of ICU stay | up to 10 days | Hours in ICU after the surgery |
| Multiorgan failure | up to 10 days | 2 or more organ dysfunction in postoperative period |
Countries
Russia
Contacts
CONTACTArtem Gubko, Ph.D.
CONTACTBoris Akselrod, Professor
PRINCIPAL_INVESTIGATORBoris Akselrod, Professor
Petrovsky NRCS
Outcome results
None listed