Early Predictive Value of Infectious Markers for Ventilator-associated Pneumonia after Stanford Type A Aortic Dissection Surgery.

Abstract

Background: This study investigates the early predictive value of infectious markers for ventilator-associated pneumonia (VAP) after Stanford type A aortic dissection surgery.

Methods: A retrospective review of the medical records of all patients with Stanford type A aortic dissection admitted to Shanghai General Hospital from July 2020 to July 2023 who received mechanical ventilation after surgery was performed. Patients were divided into infection and non-infection groups according to the presence of VAP. The clinical data of the two groups were compared. The early predictive values of procalcitonin (PCT), C-reactive protein (CRP), the neutrophil/lymphocyte ratio (NLR) and sputum smears for VAP were evaluated by receiver operating characteristic (ROC) curve analysis.

Results: A total of 139 patients with Stanford type A aortic dissection were included in this study. There were 35 cases of VAP infection, and the VAP incidence rate was 25.18%. The CRP, PCT, and NLR levels in the infection group were more significant than those in the non-infection group (p < 0.05). The percentage of positive sputum smears was 80.00% in the infected group and 77.88% in the non-infected group. The ROC curve analysis revealed that the areas under the curve (AUCs) of PCT, the NLR, CRP and sputum smear were 0.835, 0.763, 0.820 and 0.745, respectively, and the AUC for the combined diagnosis was 0.923. The pathogenic bacteria associated with VAP, after Stanford type A aortic dissection, was mainly gram-negative bacteria.

Conclusions: The combined application of the NLR, CRP, PCT and sputum smear is helpful for the early diagnosis of VAP after Stanford type A aortic dissection surgery to help clinicians make decisions about treating VAP quickly.