Preoperative Inflammatory Risk Markers and Postoperative Creatinine and Lactate as Mortality Markers After Surgery for Stanford Type A Acute Aortic Dissection

Abstract

Objective: The primary objective was to evaluate the association between preoperative platelet-to-lymphocyte ratio (PLR), measured at admission, and 30-day mortality after emergency surgical repair for Stanford type A acute aortic dissection (TAAD). Secondary analyses evaluated other preoperative inflammatory and biochemical markers, postoperative biomarker measurements as indicators of evolving postoperative physiology, and their associations with 2-year mortality. Methods: This retrospective study included 506 patients who underwent emergency surgery for TAAD. Preoperative and postoperative laboratory parameters—including creatinine, sodium, potassium, lactate, NLR, PLR, SII, and MLR—were collected along with perioperative clinical variables. Group comparisons were performed according to 30-day and 2-year mortality outcomes. Spearman correlation analysis was used to assess associations between biomarkers and clinical parameters. Receiver operating characteristic (ROC) analyses were conducted to determine the discriminative performance of inflammatory indices and biochemical markers. Statistical significance was defined as p < 0.05. Results: Non-survivors had significantly higher preoperative and postoperative creatinine levels (p = 0.008 and p = 0.003), longer aortic cross-clamp and circulatory arrest times (both p < 0.001), and elevated postoperative lactate levels (p = 0.029). All inflammatory indices—including NLR, PLR, and SII—were markedly higher in patients who died within 30 days (all p < 0.001). MLR was also significantly elevated in non-survivors, although the magnitude of increase was more modest compared with the other inflammatory indices (preoperative p = 0.011; postoperative p = 0.007–0.010). In the primary analysis, preoperative PLR showed good discrimination for 30-day mortality (AUC 0.819, 95% CI 0.750–0.889) and remained independently associated with 30-day mortality after adjustment for age, preoperative creatinine, aortic cross-clamp time, and total circulatory arrest time (adjusted OR 1.004, 95% CI 1.002–1.007; p < 0.001). Postoperative inflammatory indices, creatinine, and lactate were also associated with mortality and were interpreted as markers of evolving postoperative physiological deterioration, whereas sodium showed no meaningful prognostic contribution. For 2-year mortality, elevated preoperative and postoperative creatinine and lactate levels, together with persistently higher inflammatory indices at all measured time points, were significantly associated with long-term death (all p < 0.001). No inflammatory index showed a meaningful correlation with postoperative complications. Conclusions: Preoperative PLR was associated with 30-day mortality after TAAD surgery. Postoperative inflammatory indices; creatinine; and lactate were also associated with mortality but may primarily have reflected evolving postoperative physiological deterioration. Prospective multicenter validation is required before these biomarkers are incorporated into clinical risk models or used to guide management decisions.