Skip to main content
Download PDF

Risk factors for postoperative hepatic dysfunction in overweight patients with acute type A aortic dissection

BMC Surgery volume 24, Article number: 305 (2024) Cite this article

Abstract

Background

Acute hepatic dysfunction (AHD) is a common postoperative complication in patients with acute type A aortic dissection. The aim of this study was to identify risk factors for acute hepatic dysfunction after surgery for acute type A aortic dissection.

Methods

We performed a retrospective study from March 1, 2019, to February 28, 2021. The primary endpoints of this study were morbidity due to AHD and risk factors for incidence. Univariate analysis and multivariate logistic regression analysis were used to analyse the related factors, and receiver operating characteristic (ROC) curves were plotted to evaluate their predictive value.

Results

Among 147 patients, 29 (19.73%) developed postoperative acute hepatic dysfunction, and 9 (6.12%) died. Univariate analysis revealed that the ALT (P = 0.042), Cr (P < 0.001), and BUN (P = 0.008) levels were significantly different between the two groups. Multivariate logistic regression analysis revealed that Cr (OR = 1.013, 95% CI = 1.003–1.023, P = 0.008) was an independent risk factor for postoperative hepatic dysfunction in overweight (BMI > 24) patients with ATAAD. The area under the ROC curve (AUC) for Cr was 0.745 > 0.7, indicating good predictive value.

Conclusion

A high Cr concentration is an independent risk factor for postoperative AHD in overweight (BMI > 24) patients with ATAAD.

Peer Review reports

Acute hepatic dysfunction is a common postoperative complication in patients with acute type A aortic dissection. Once diagnosed with ATAAD, surgical treatment is the only way to save the patient’s life [1, 2], however, with the development of endovascular technology, a subset of special acute type A aortic dissections may be resolved by endovascular treatment. Moreover, in recent years, with improvements in surgical techniques, the perioperative mortality rate of ATAAD patients has greatly decreased [3]. However, perioperative complications strongly affect the patient prognosis [4]. Acute hepatic dysfunction (AHD) is a common postoperative complication of ATAAD and is closely related to the patient prognosis [5]. The incidence of acute liver failure after cardiac-related surgery is approximately 13% [6], and cardiopulmonary bypass increases the rate of acute liver injury, leading to death [7]. Obesity is closely related to postoperative mortality in patients with ATAAD [8]. The body mass index (BMI) is positively associated with the incidence of severe adverse outcomes in patients who undergo ATAAD [9]. The MELD score is a good model for evaluating the occurrence of acute dysfunction after surgery. The MELD score is calculated as MELD = 11.2In (INR) + 3.8ln[bilirubin (mg/mL)] + 9.6 In [serum creatinine (µmol/L)] + 6.4× cause (biliary or alcoholic = 0; Other = 1) [10]. However, studies on the risk factors for acute liver injury in overweight patients with ATAAD are rare. In this study, relevant data on overweight ATAAD patients were retrospectively analysed, and the risk factors for acute hepatic insufficiency after surgery were discussed to provide a theoretical basis for the clinical treatment of these diseases.

Methods

We retrospectively analysed the clinical data of 147 overweight (BMI > 24) patients with ATAAD at the Affiliated Hospital of Kunming University of Science and Technology from March 1, 2019, to February 28, 2021. All the patients were diagnosed with ATAAD by CTA before surgery, and all underwent surgical treatment. There were 109 males and 38 females with an average age of 51.04 ± 10.17 years.

The patients’ basic information, including age, sex, weight, height, history of hypertension, smoking status, diabetes status, hospital white blood cells, neutrophils, lymphocytes and neutrophils/lymphocytes, red blood cells deposited, platelet count, APTT, PT and INR, FIB, FDP, DD2, LVEF, AST, ALT, TBIL, UBIL, albumin, Cr, BUN, K, Na, Cl, Ca, CKMB, aTn1, MYO, intraoperative infusion, platelets, red blood cell count, plasma, transit time, deep low-temperature cycle time stopped, aorta blocking time, intraoperative minimum anus temperature, and minimum nasal temperature, was collected. According to the postoperative bilirubin concentration, INR, and postoperative creatinine level, the patients were divided into an experimental group and a control group according to their MELD score (patients with MELD scores < 15 were defined as the liver dysfunction group, and patients with MELD scores > 15 were defined as the liver dysfunction group). Patient blood samples were used to evaluate the first preoperative blood index after admission and to obtain intraoperative and postoperative data.

All surgeries were standardized for all patients, and patients who underwent endovascular repair were not included. All the operations were performed under deep hypothermic circulatory arrest. The Bentall procedure [11] was used in 20 patients, and 127 patients underwent Sun’s operation [12]. A flowchart of the study is shown in Fig. 1.

Fig. 1
figure 1

The flow chart of the study

Full size image

SPSS 26.0 was used for data analysis. The t test, rank sum test and chi-square test were used for normally distributed data, nonnormally distributed data and count data, respectively. Logistic regression models were used to identify univariate and multivariate risk factors for postoperative HD. ROC curves were drawn to evaluate the predictive value. Flow charts were generated via GraphPad Prism software.

Results

A total of 147 patients (109 males and 38 females) were included in this study; the average age was 51.04 ± 10.17 years, and the average BMI was 27.53. The medical history collected included hypertension (74.83%), diabetes (7.48%), and smoking history (53.74%). Sun’s procedure was performed in 127 patients, and 20 patients underwent the Bentall procedure. All the patients were divided into two groups according to their MELD score. The mean MELD score of all the patients was 11.68. Patients with a MELD score < 15 were defined as the nonhepatic dysfunction group, for which the average MELD score was 10.03. Patients with a MELD score > 15 were defined as the hepatic dysfunction group, for which the average MELD score was 18.38. There were 84 males and 34 females in the nonhepatic insufficiency group and 25 males and 4 females in the hepatic dysfunction group. In the nonhepatic insufficiency group, 89 patients had a history of high blood pressure (22 females and 67 males), 60 patients had a smoking history (2 females and 58 males), and 9 patients had a history of diabetes (2 females and 7 males). In the hepatic insufficiency group, 21 patients had hypertension (2 females and 19 males), 19 patients had a smoking history (19 males), 2 patients had a history of diabetes (2 males), the mean white blood cell count was 12.39 ± 3.59 (x10^9/L), the mean neutrophil count was 10.21 ± 3.53 (x10^9/L), and the median and interquartile range of lymphocytes was 1.16 (0.74, 1.67). The median preoperative creatinine level was 113 µmol/L. Among the 147 patients, the celiac artery and superior mesenteric artery were not involved in 4 patients, and dissection in the other patients involved the celiac artery and superior mesenteric artery (although the dissection involved the celiac trunk and superior mesenteric artery, liver function was not significantly impaired before the operation). Moreover, 9 patients died (3 patients with haemorrhagic shock, 2 patients with electrolyte disturbance, 1 patient with renal failure, 1 patient with coagulation collapse, and 2 patients with longitudinal cadmium infection). Postoperative renal insufficiency occurred in 44 patients (7 patients were treated with haemodialysis, 1 of whom died), 59 patients had different degrees of pulmonary infection, and 9 patients had severe thrombocytopenia (possibly caused by heparin-induced thrombocytopenia). The basic data of the patients are shown in Table 1. Nine patients died in the hospital (6.12%), eight in the hepatic insufficiency group and one in the nonhepatic insufficiency group.

Table 1 Basic clinical data and univariate analysis of overweight ATAAD patients
Full size table

As shown in Table 1, univariate analysis revealed no statistically significant differences in sex, age, hypertension status, diabetes status, smoking status, WBC count, neutrophil count, granulocyte count, lymphocyte count, or neutrophil/lymphocyte ratio between the 2 groups. There were statistically significant differences (P < 0.05) in the preoperative ALT level (P = 0.042), preoperative Cr level (P < 0.001), and preoperative BUN level (P = 0.008) between the 2 groups. The multivariable analyses of risk factors for postoperative AHD included the preoperative ALT level, preoperative Cr level, and preoperative BUN level, and the multivariate logistic regression analysis revealed that preoperative Cr (P = 0.008, 95% CI = 1.003–1.023, OR = 1.013) was a risk factor for postoperative AHD in overweight patients with acute aortic dissection (Table 2). ROC curves were generated to explore the predictive ability and cut-off value of preoperative Cr for postoperative AHD. As shown in Fig. 2, the area under the curve (AUC) of the preoperative Cr level used for predicting postoperative AHD in patients with ATAAD was 0.745 > 0.7 (cut-off: 107 U/L; sensitivity: 0.586; specificity: 0.856), indicating good predictive value (Table 3; Fig. 2).

Table 2 Multifactor Logistics regression analysis of risk factors for postoperative AHD in overweight ATAAD patients
Full size table
Fig. 2
figure 2

ROC curve of Cr predicts hepatic dysfunction in overweightpatients with overweight ATAAD

Full size image
Table 3 ROC curve of Cr predicts postoperative AHD in overweight ATAAD patients
Full size table

Discussion

Few studies have reported risk factors for postoperative AHD in overweight patients with ATAAD. In this study, a total of 38 overweight patients with ATAAD developed postoperative AHD, and 9 patients ultimately died; 8 patients in the hepatic dysfunction group (3 patients with haemorrhagic shock due to severe postoperative bleeding, 2 patients with electrolyte disturbance, 1 patient with renal failure, and 2 patients with mediastinal infection) and 1 patient in the nonhepatic dysfunction group died of postoperative coagulation collapse. The overall mortality rate was 6.12%. Multivariate logistic regression analysis revealed that preoperative Cr was an independent risk factor for postoperative AHD in overweight patients with acute AAD.

Overweight and obesity have recently been identified as risk factors for many diseases [13,14,15]. Similarly, a high body mass index (BMI) has been found to be associated with a high risk of adverse outcomes in patients undergoing cardiac surgery [16, 17]. A total of 9 patients died in this study, and the mortality rate was 6.12%, which is similar to or even lower than that reported in previous studies. Several large studies have shown that overweight and obese patients are more likely than healthy individuals to have serious complications after surgery, leading to death [18]. Therefore, early detection of postoperative hepatic dysfunction in overweight patients with ATAAD could reduce the incidence of complications and mortality.

In one study, the incidence of postoperative hepatic dysfunction in patients with ATAAD was approximately 25.4% [19], which is slightly different from the incidence reported in our study, possibly because of the use of different inclusion criteria. Most patients with acute type A aortic dissection have involvement of the abdominal branch artery, which can lead to dysfunction. Moreover, dissection involves the aortic valve proximally, and even complications such as pericardial tamponade can lead to ischaemic damage to liver function. Additionally, after a long operation, the release of systemic inflammatory factors increases the burden on liver function to some degree, leading to liver insufficiency.

In this study, multivariate logistic regression analysis revealed that preoperative Cr was an independent risk factor for postoperative AHD in overweight patients with acute AAD, indicating that preoperative renal dysfunction may lead to postoperative hepatic dysfunction and even failure. First, a high preoperative creatinine level indicates a certain degree of renal injury, and the concentration of erythropoietin (EPO) is correspondingly reduced. EPO is a protective factor for multiple organs, including the kidney [20]. Second, owing to the rapid development of ATAAD, dissection involves the blood supply to multiple organs [21]. The body cannot redistribute blood in a short time, and impaired renal function further leads to a sharp reduction in liver tolerance, toxic clearance and metabolism, greatly increasing the likelihood of postoperative acute liver injury. Third, overweight patients often have a degree of liver and kidney steatosis [22]. In metabolic disorders, liver function and kidney function form a vicious cycle, leading to irreversible liver and kidney failure. A meta-analysis revealed that the incidence of acute kidney injury after ATAAD surgery was as high as 50.7% [23]. A large amount of oestrogen is produced in the adipose tissue of overweight and obese patients [24,25,26]. Fourth, oestrogen can inhibit the formation and secretion of very low-density lipoprotein in the liver [27], inhibit the export of fat from the liver, and aggravate liver function damage to a certain extent. Finally, the occurrence of preoperative renal dysfunction and postoperative hepatic dysfunction may be related to the hepatorenal reflex, but this has not been clearly confirmed in ATAAD-related diseases [28].

Several studies have investigated the occurrence of AHD after ATAAD surgery, but few have examined the occurrence of AHD after ATAAD surgery in overweight patients. Overweight and obesity have been hot topics in recent years and are the basis of a variety of cardiovascular diseases. Preoperative Cr is an independent risk factor for postoperative AHD in overweight patients with acute AAD. This fact will not only enable clinicians to identify and prevent serious complications early but also provide ideas for research on serious cardiovascular diseases caused by overweight and obesity. Moreover, this study revealed that more than one quarter of patients with severe ATAAD developed AHD after surgery, which suggests that we should pay attention to the occurrence of such complications, actively monitor changes in liver function before and after surgery and intervene as soon as possible for possible serious complications. In addition, we should carry out individualized diagnosis and treatment for patients with severe disease, which is conducive to a good prognosis.

Because acute type A aortic dissection often involves the coronary arteries and sinuses of Valsalva, endovascular treatment alone is of limited utility. Although some large hospitals have attempted to repair acute type A aortic dissection via endovascular techniques, the repair technology is not yet mature. However, endovascular treatment of acute type A aortic dissection can reduce many complications caused by thoracotomy to a certain extent and is conducive to patient recovery, suggesting a direction for future research.

This study has several limitations. (1) The sample size was small, and large-sample studies in large centres are needed to confirm the results. (2) Overweight was defined according to the calculation of weight for height, not for body surface area or fat distribution, to perform more detailed research. (3) All the operations were performed by two surgeons, and there was bias. (4) The type and dose of anaesthetic drugs used during surgery may have contributed to hepatic insufficiency.

Conclusions

This study underscores the morbidity and mortality of postoperative AHD following ATAAD repair surgery, elevated creatinine is an independent risk factor for postoperative acute hepatic insufficiency in overweight patients with ATAAD.

Data availability

All data generated or analysed during this study are included in this published article. The corresponding author can provide all the original data included about this manuscript.

Abbreviations

ATAAD:

Acute type a aortic dissection

BMI:

Body Mass Index

AHD:

Acute hepatic dysfunction

MELD:

Model of end-stage liver disease

OR:

Odds ratio

CI:

Confdence interval

BUN:

Blood Urea Nitrogen

Cr:

Creatinine

CKMB:

Creatine Kinase-MB

MYO:

Myoglobin

References

  1. Wundram M, Falk V, Eulert-Grehn JJ, Herbst H, Thurau J, Leidel BA, Göncz E, Bauer W, Habazettl H, Kurz SD. Incidence of ATAAD in emergency departments. Sci Rep. 2020;10(1):7434.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Malaisrie SC, Szeto WY, Halas M, Girardi LN, Coselli JS, Sundt TM 3rd, Chen EP, Fischbein MP, Gleason TG, Okita Y, Ouzounian M, Patel HJ, Roselli EE, Shrestha ML, Svensson LG, Moon MR, AATS Clinical Practice Standards Committee. Adult cardiac surgery. 2021 the American Association for Thoracic Surgery expert consensus document: Surgical treatment of ATAAD. J Thorac Cardiovasc Surg. 2021;162(3):735–e7582.

    Article  PubMed  Google Scholar 

  3. Elsayed RS, Cohen RG, Fleischman F, Bowdish ME. ATAAD Cardiol Clin. 2017;35(3):331–45.

    Article  Google Scholar 

  4. An KR, de Mestral C, Tam DY, Qiu F, Ouzounian M, Lindsay TF, Wijeysundera HC, Chung JC. Surveillance Imaging following ATAAD. J Am Coll Cardiol. 2021;78(19):1863–71.

    Article  PubMed  Google Scholar 

  5. Lin X, Xie L, Jiang D, Wu Q, He J, Chen L. Hepatic dysfunction and adverse outcomes after total arch repair of ATAAD: application of the MELD-XI score. BMC Cardiovasc Disord. 2022;22(1):491.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Nishi H, Takahashi T, Ichikawa H, Matsumiya G, Matsuda H, Sawa Y. Prediction of postoperative hepatic dysfunction after cardiac surgery in patients with chronic congestive heart failure. Gen Thorac Cardiovasc Surg. 2009;57(7):357–62.

    Article  PubMed  Google Scholar 

  7. Di Tomasso N, Monaco F, Landoni G. Hepatic and renal effects of cardiopulmonary bypass. Best Pract Res Clin Anaesthesiol. 2015;29(2):151–61.

    Article  PubMed  Google Scholar 

  8. Pan X, Xing Z, Yang G, Ding N, Zhou Y, Chai X. Obesity increases In-Hospital mortality of ATAAD patients Undergoing Open Surgical repair: a retrospective study in the Chinese Population. Front Cardiovasc Med. 2022;9:899050.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lin L, Lin Y, Chen Q, Peng Y, Li S, Chen L, Huang X. Association of body mass index with in-hospital major adverse outcomes in ATAAD patients in Fujian Province, China: a retrospective study. J Cardiothorac Surg. 2021;16(1):47.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chokshi A, Cheema FH, Schaefle KJ, Jiang J, Collado E, Shahzad K, Khawaja T, Farr M, Takayama H, Naka Y, Mancini DM, Schulze PC. Hepatic dysfunction and survival after orthotopic heart transplantation: application of the MELD scoring system for outcome prediction. J Heart Lung Transpl. 2012;31(6):591–600.

    Article  Google Scholar 

  11. Mookhoek A, Korteland NM, Arabkhani B, Di Centa I, Lansac E, Bekkers JA, Bogers AJ, Takkenberg JJ. Bentall Procedure: a systematic review and Meta-analysis. Ann Thorac Surg. 2016;101(5):1684–9.

    Article  PubMed  Google Scholar 

  12. Sun GL, Sun LZ, Zhu JM, Liu YM, Ge YP, Xu SJ. Clinical characteristics and risk factors for fatal outcome of patients receiving Sun’s procedure after previous cardiac surgery. Asian J Surg. 2021;44(1):87–92.

    Article  PubMed  Google Scholar 

  13. Wahl S, Drong A, Lehne B, Loh M, Scott WR, Kunze S, Tsai PC, Ried JS, Zhang W, Yang Y, Tan S, Fiorito G, Franke L, Guarrera S, Kasela S, Kriebel J, Richmond RC, Adamo M, Afzal U, Ala-Korpela M, Albetti B, Ammerpohl O, Apperley JF, Beekman M, Bertazzi PA, Black SL, Blancher C, Bonder MJ, Brosch M, Carstensen-Kirberg M, de Craen AJ, de Lusignan S, Dehghan A, Elkalaawy M, Fischer K, Franco OH, Gaunt TR, Hampe J, Hashemi M, Isaacs A, Jenkinson A, Jha S, Kato N, Krogh V, Laffan M, Meisinger C, Meitinger T, Mok ZY, Motta V, Ng HK, Nikolakopoulou Z, Nteliopoulos G, Panico S, Pervjakova N, Prokisch H, Rathmann W, Roden M, Rota F, Rozario MA, Sandling JK, Schafmayer C, Schramm K, Siebert R, Slagboom PE, Soininen P, Stolk L, Strauch K, Tai ES, Tarantini L, Thorand B, Tigchelaar EF, Tumino R, Uitterlinden AG, van Duijn C, van Meurs JB, Vineis P, Wickremasinghe AR, Wijmenga C, Yang TP, Yuan W, Zhernakova A, Batterham RL, Smith GD, Deloukas P, Heijmans BT, Herder C, Hofman A, Lindgren CM, Milani L, van der Harst P, Peters A, Illig T, Relton CL, Waldenberger M, Järvelin MR, Bollati V, Soong R, Spector TD, Scott J, McCarthy MI, Elliott P, Bell JT, Matullo G, Gieger C, Kooner JS, Grallert H, Chambers JC. Epigenome-wide association study of body mass index, and the adverse outcomes of adiposity. Nature. 2017;541(7635):81–86.

  14. Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol. 2021;9(6):373–92.

    Article  PubMed  Google Scholar 

  15. Katta N, Loethen T, Lavie CJ, Alpert MA. Obesity and Coronary Heart Disease: Epidemiology, Pathology, and coronary artery imaging. Curr Probl Cardiol. 2021;46(3):100655.

    Article  PubMed  Google Scholar 

  16. Dwivedi AK, Dubey P, Cistola DP, Reddy SY. Association between Obesity and Cardiovascular outcomes: updated evidence from Meta-analysis studies. Curr Cardiol Rep. 2020;22(4):25.

    Article  PubMed  Google Scholar 

  17. Djouani A, Smith A, Choi J, Lall K, Ambekar S. Cardiac surgery in the morbidly obese. J Card Surg. 2022;37(7):2060–71.

    Article  PubMed  Google Scholar 

  18. Möller CM, Ellmauer PP, Zeman F, Bitzinger D, Flörchinger B, Graf BM, Zausig YA. Postoperative acute respiratory dysfunction and the influence of antibiotics after ATAAD surgery: a retrospective analysis. PLoS ONE. 2021;16(2):e0246724.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Liang S, Liu Y, Zhang B, Dun Y, Guo H, Qian X, Sun X. Postoperative hepatic dysfunction after frozen Elephant trunk for type A aortic dissection. Front Cardiovasc Med. 2021;8:739606.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bahlmann FH, Fliser D. Erythropoietin and renoprotection. Curr Opin Nephrol Hypertens. 2009;18(1):15–20.

    Article  PubMed  CAS  Google Scholar 

  21. Ghoreishi M, Wise ES, Croal-Abrahams L, Tran D, Pasrija C, Drucker CB, Griffith BP, Gammie JS, Crawford RS, Taylor BS. A novel risk score predicts Operative Mortality after ATAAD Repair. Ann Thorac Surg. 2018;106(6):1759–66.

    Article  PubMed  Google Scholar 

  22. Wang TY, Wang RF, Bu ZY, Targher G, Byrne CD, Sun DQ, Zheng MH. Association of metabolic dysfunction-associated fatty liver disease with kidney disease. Nat Rev Nephrol. 2022;18(4):259–68.

    Article  PubMed  Google Scholar 

  23. Wang L, Zhong G, Lv X, Dong Y, Hou Y, Dai X, Chen L. Risk factors for acute kidney injury after Stanford type A aortic dissection repair surgery: a systematic review and meta-analysis. Ren Fail. 2022;44(1):1462–76.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Tchernof A, Després JP. Pathophysiology of human visceral obesity: an update. Physiol Rev. 2013;93(1):359–404.

    Article  PubMed  CAS  Google Scholar 

  25. Nelson LR, Bulun SE. Estrogen production and action. J Am Acad Dermatol. 2001;45(3 Suppl):S116–24.

    Article  PubMed  CAS  Google Scholar 

  26. Torres Irizarry VC, Jiang Y, He Y, Xu P. Hypothalamic estrogen signaling and adipose tissue metabolism in Energy Homeostasis. Front Endocrinol (Lausanne). 2022;13:898139.

    Article  PubMed  Google Scholar 

  27. Campos H, Walsh BW, Judge H, Sacks FM. Effect of estrogen on very low density lipoprotein and low density lipoprotein subclass metabolism in postmenopausal women. J Clin Endocrinol Metab. 1997;82(12):3955–63.

    PubMed  CAS  Google Scholar 

  28. Rzouq F, Alahdab F, Olyaee M. New insight into volume overload and hepatorenal syndrome in cirrhosis, the hepatorenal reflex hypothesis. Am J Med Sci. 2014;348(3):244–8.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Thanks to the department of General Surgery, Affiliated Hospital of Kunming University of Science and Technology, for supporting this research data.

Funding

This study was supported by the Research Project of Sichuan Geriatrics Society (No. 24SCLN064).

Author information

Authors and Affiliations

  1. Panzhihua Central Hospital, 34 Yikang St, Panzhihua, Sichuan Province, 617000, China

    Yu Xu & Yong-Jiang Tang

  2. The Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming City, Yunnan Province, 650500, China

    Lin-Zhuo Liu, Hong-Qiao Lu, Xin-Qing Yang, Shi-Kui Guo & Kun-Mei Gong

Authors
  1. Yu Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lin-Zhuo Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hong-Qiao Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xin-Qing Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shi-Kui Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yong-Jiang Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kun-Mei Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Yu Xu, Lin-Zhuo Liu and Hong-Qiao Lu wrote and revised the manuscript and share first author, Xin-Qing Yang and Yu Xu analyzed the data and drew pictures. Hong-Qiao Lu designed the experimental procedure and scheme, Shi-Kui Guo, Yong-Jiang Tang and Kun-Mei Gong reviewed and revised the manuscript. All authors contributed to the article and approved the final manuscript.

Corresponding authors

Correspondence to Shi-Kui Guo, Yong-Jiang Tang or Kun-Mei Gong.

Ethics declarations

Ethics approval and consent to participate

This study has been approved by the Ethics Committee of Kunming University of Science and Technology, The approval number is KMUST-MEC-091. All included patients were informed and consented to this study. Informed consent to participate was obtained from all of the participants in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Yu Xu, Lin-Zhuo Liu and Hong-Qiao Lu are co-first authors.

Shi-Kui Guo, Yong-Jiang Tang and Kun-Mei Gong are co-corresponding authors.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xu, Y., Liu, LZ., Lu, HQ. et al. Risk factors for postoperative hepatic dysfunction in overweight patients with acute type A aortic dissection. BMC Surg 24, 305 (2024). https://doi.org/10.1186/s12893-024-02621-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12893-024-02621-x

Keywords

BMC Surgery

ISSN: 1471-2482

Contact us