Key result
Low serum ACE2 levels (≤1.01 ng/ml) on preoperative day 1 were independently associated with a significantly higher risk of in-hospital mortality following open surgical repair for ruptured AAA compared to levels ≥1.80 ng/ml (HR 6.1).
Why the study?
Does low preoperative serum ACE2 level predict in-hospital mortality in patients undergoing open surgical repair for ruptured abdominal aortic aneurysm?
Cohort (n=84)
No
Does low preoperative serum ACE2 level predict in-hospital mortality in patients undergoing open surgical repair for ruptured abdominal aortic aneurysm?
Hazard Ratio: 6.1 (95% CI 3.3–23.8)
Absolute Event Rate: 66.7% vs 9.5%
p-value: p=<0.001
Low preoperative serum ACE2 levels are an independent risk factor for in-hospital mortality following open surgical repair of ruptured abdominal aortic aneurysms.
Should not yet guide decisions in ruptured AAA repair; leaves open ACE2's value as a prognostic biomarker.
Open surgical repair (OSR) is a conventional surgical method used in the repair a ruptured abdominal aortic aneurysm (AAA); however, OSR results in high perioperative mortality rates. The level of serum angiotensin-converting enzyme 2 (ACE2) has been reported to be an independent risk factor for postoperative in-hospital mortality following major cardiopulmonary surgery. In the present study, the association of serum ACE2 levels with postoperative in-hospital mortality was investigated in patients undergoing OSR for ruptured AAA. The study enrolled 84 consecutive patients underwent OSR for ruptured AAA and were subsequently treated in the intensive care unit. Patients who succumbed postoperatively during hospitalization were defined as non-survivors. Serum ACE2 levels were measured in all patients prior to and following the surgery using ELISA kits. The results indicated that non-survivors showed significantly lower mean preoperative and postoperative serum ACE2 levels when compared with those in survivors. Multivariate logistic regression analysis also showed that, subsequent to adjusting for potential confounders, the serum ACE2 level on preoperative day 1 showed a significant negative association with the postoperative in-hospital mortality. This was confirmed by multivariate hazard ratio analysis, which showed that, subsequent to adjusting for the various potential confounders, the risk of postoperative in-hospital mortality remained significantly higher in the two lowest serum ACE2 level quartiles compared with that in the highest quartile on preoperative day 1. In conclusion, the present study provided the first evidence supporting that the serum ACE2 level is an independent risk factor for the in-hospital mortality following OSR for ruptured AAA. Furthermore, low serum ACE2 levels on preoperative day 1 were found to be associated with increased postoperative in-hospital mortality. Therefore, the serum ACE2 level on preoperative day 1 may be a potential biomarker or prognostic factor for in-hospital mortality following OSR for ruptured AAA.
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Nie et al. (2016) conducted a cohort in Ruptured abdominal aortic aneurysm (AAA) (n=84). Low serum ACE2 level on preoperative day 1 (≤1.01 ng/ml) vs. High serum ACE2 level (≥1.80 ng/ml) was evaluated on Postoperative in-hospital mortality (HR 6.1, 95% CI 3.3-23.8, p=<0.001). Low serum ACE2 levels (≤1.01 ng/ml) on preoperative day 1 were independently associated with a significantly higher risk of in-hospital mortality following open surgical repair for ruptured AAA compared to levels ≥1.80 ng/ml (HR 6.1).
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