Admission creatinine level predicts postoperative acute hepatic dysfunction in patients aged ≤30 years with acute type A aortic dissection: a multi-center retrospective study.

BACKGROUND: This study aimed to investigate the risk factors for postoperative acute hepatic dysfunction in patients aged ≤30 years with acute type A aortic dissection (ATAAD). METHODS: This retrospective study included clinical data from patients who underwent surgery for acute type A aortic dissection (ATAAD) at Fujian Medical University Union Hospital, Xiangya Hospital of Central South University, and Henan Provincial Chest Hospital. Eligible patients were divided into an acute hepatic dysfunction (AHD) group and a non-AHD group according to their MELD scores. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for postoperative AHD. Subsequently, a receiver operating characteristic (ROC) curve was generated to assess the predictive performance of the identified factors. RESULTS: A total of 122 patients were enrolled, comprising 100 males (81.97%) and 22 females (18.03%), with a median age of 28.00 years (IQR: 25.00-29.00). Postoperative AHD occurred in 34 patients (27.87%), who were assigned to the AHD group, while the remaining 88 patients (72.13%) formed the non-AHD group. Baseline comparisons revealed significant differences between the two groups in history of hypertension, white blood cell count, neutrophil count, lymphocyte count, lymphocyte-to-monocyte ratio (LMR), pan-immune-inflammation value (PIV), systemic inflammation response index (SIRI), total protein (TP), albumin, creatinine (Cr), prothrombin time (PT), and INR (all P < 0.05). Multivariate logistic regression identified Cr as an independent risk factor for postoperative AHD in ATAAD patients aged ≤30 years (OR = 1.04, 95% CI: 1.01-1.06, P = 0.002). The ROC curve demonstrated that Cr had good predictive value (AUC = 0.816, 95% CI: 0.727-0.906; P < 0.0001), with a sensitivity of 0.765 and a specificity of 0.773. CONCLUSION: Elevated admission serum creatinine level is associated with an increased risk of postoperative acute hepatic dysfunction in patients aged 30 years or younger with acute type A aortic dissection. Accordingly, routine assessment and serial monitoring of this biomarker are essential for the early identification of high-risk individuals and for optimizing perioperative management.