The short-term prognostic value of serum platelet to hemoglobin in patients with type A acute aortic dissection

Perfusion ◽  
2020 ◽  
pp. 026765912098222
Author(s):  
Yu Wang ◽  
Tengfei Qiao ◽  
Jun Zhou
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Acute Aortic Dissection ◽  
Independent Predictor ◽  
Type A ◽  
Short Term ◽  
Survivor Group ◽  
Mortality Hazard ◽  
Mortality Hazard Ratio ◽  
The Ideal

Purpose: Type A acute aortic dissection (AAD) is an uncommon catastrophic cardiovascular disease with high pre-hospital mortality rate without timely and effectively treated. The aim of this study was to assess the value of serum platelet to hemoglobin (PHR) in predicting in-hospital mortality in type A AAD patients. Methods: A total of 183 type A AAD patients were included in this retrospective investigation from January 2017 to December 2019. Admission blood routine parameters were gathered and PHR was computed. The outcome was all-cause in-hospital mortality within 30 days. Results The average levels of serum PHR were significant higher in survivor group than those in non-survivor group (1.14 ± 0.57 vs 0.87 ± 0.47, p = 0.006) and serum PHR was an independent factor associated with in-hospital mortality (hazard ratio (HR): 2.831; 95% confidence interval (CI): 1.108–7.231; p = 0.030). ROC noted that 0.8723 was chosen as the ideal cutoff value with a sensitivity of 64.3% and specificity of 72.5%. In addition, the area under the ROC curve (AUC) was 0.693 (95% CI 0.599–0.787, p < 0.001). Conclusion: Admission serum PHR can be used as an independent predictor of in-hospital mortality in patients with type A AAD.

scholarly journals Admission Values of Plasma Biomarkers Predict the Short-Term Outcomes in Acute Aortic Dissection

2021 ◽  
Vol 24 (1) ◽  
pp. E048-E054
Author(s):  
Nan Xie ◽  
Wei Zhang ◽  
Hong Li ◽  
Jing Zhou ◽  
Xinyi Yang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Subgroup Analysis ◽  
Regression Models ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Short Term ◽  
Logistic Regression Models ◽  
The Impact ◽  
D Dimer

Background and aims: Acute aortic dissection (AAD) is an emergency disease with high misdiagnosis rate and mortality. The aim of the present study is to explore the impact of blood-related biomarkers, specifically D-dimer, on in-hospital outcomes of patients with AAD. Materials and methods: A total of 345 patients in our hospital from December 2013 to April 2017 were included. The cutoff value for D-dimer and LDL-C were set as 5.9mg/l and 1.45 mg/l, respectively. The univariate and multivariate logistic regression models were used to identify the independently prognostic predictors. Results: The results showed that patients with type A AAD had higher risk of in-hospital mortality compared with those with type B disease. Moreover, results revealed the type A AAD (OR 6.382, 95%CI: 2.423 to 16.812), D-dimer (OR 2.160, 95%CI: 1.072 to 4.350), and LDL-C (OR 0.373, 95%CI: 0.148 to 0.940) were independently associated with in-hospital mortality. Subgroup analysis suggested that D-dimer (OR 2.295, 95%CI: 1.140 to 4.622) was an independently prognostic factor in type A AAD. Conclusion: In summary, D-dimer ≥5.9 mg/L and type A AAD were independently associated with in-hospital mortality in AAD patients. Moreover, subgroup analysis proved that the elevated D-dimer was related to poor prognosis in type A AAD.

P5599Prognostic impact of quality indicators on outcomes of acute aortic dissection in Japan

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Yamaguchi ◽  
M Nakai ◽  
Y Sumita ◽  
Y Miyamoto ◽  
H Matsuda ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Quality Indicators ◽  
Acute Aortic Dissection ◽  
Vascular Diseases ◽  
Type A ◽  
Administrative Database ◽  
Type B ◽  
Practice Gaps

Abstract Background Despite recent advances in diagnosis and management, the mortality of acute aortic dissection (AAD) remains high. Purpose This study aims to develop quality indicators (QIs) for the management of AAD, and to evaluate the associations between QIs and outcomes of AAD in a Japanese nationwide administrative database. Methods A total of 18,348 patients suffered from AAD (Type A: 10,131, Type B: 8,217) in the Japanese Registry of All Cardiac and Vascular Diseases database between 2012 and 2015 were studied. A systematic review was performed to establish initial index items for QIs. Evaluation was performed through the expert consensus meeting using a Delphi method. Associations between developed QIs and the mortality were determined by multivariate mixed logistic regression analyses. Results A total of nine QIs (five structural and four processatic) were developed. Achievements of developed QIs (High: 7–9, Middle: 4–6, Low: 0–3) were significantly associated with lower in-hospital mortality even after adjustment for covariates in both type A (Middle: odds ratio [OR], 0.257; 95% confidence interval [CI], 0.211–0.312; P<0.001; High: OR, 0.064; 95% CI, 0.047–0.086; P<0.001 vs. Low) and type B (Middle: OR, 0.447; 95% CI, 0.338–0.590; P<0.001; High: OR, 0.128; 95% CI, 0.077–0.215; P<0.001 vs. Low). Additionally, achievements of structural and processatic QIs were consistently associated with reduced in-hospital mortality. QIs and in-hospital mortality Conclusions Developed QIs for AAD management were significantly associated with lower in-hospital mortality. Evaluation of each hospital's management with QIs could be helpful to equalize quality of treatment and to fill the evidence-to-practice gaps in the real-world treatment.

scholarly journals Prevalence, Clinical Features, and In-hospital Outcome of Fatty Liver Disease in Acute Aortic Dissection: A Single-Center Retrospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Yifan Zuo ◽  
Xin Cai ◽  
Zhiwei Wang ◽  
Zhipeng Hu ◽  
Zhiyong Wu ◽  
...  
Keyword(s):  
Liver Disease ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Fatty Liver ◽  
Clinical Features ◽  
Fatty Liver Disease ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Type B ◽  
Hospital Outcome

Background and Aims: Fatty liver disease (FLD) has emerged as a major public issue in China. We aim to investigate prevalence, clinical features, and in-hospital outcome of FLD in acute aortic dissection (AAD) patients.Methods: Data of 379 AAD patients from 2017 to 2019 at Renmin hospital of Wuhan University was retrospectively collected and divided according to age and FLD absence. Propensity score matching was used for minimal confounding. We compared their physical environmental parameter of onset, clinical features, and in-hospital outcome.Results: The mean age was 52.0 ± 11.5 years in type A and 55.1 ± 11.4 in type B. 25.0% of type A and 19.2% of type B AAD patients had FLD. Logistic regression indicated a negative association between FLD and age, both in type A [unadjusted odds ratio (OR) 0.958 (per 1 year), 95% confidence interval (CI) 0.930–0.988, p = 0.0064] and type B [unadjusted OR 0.943 (per 1 year), 95% CI 0.910–0.978, p = 0.0013]. After matching, type A with FLD had onset with a lower air quality index (AQI) of 68.5 [interquartile range (IQR) 46.0–90.0] and a lower Pm 2.5 concentration of 36.0 μg/m3 (IQR 23.0–56.0) compared with non-FLD group. In Kaplan-Meier estimation, FLD was associated with higher risk of in-hospital mortality in type B AAD (p = 0.0297).Conclusion: The prevalence of FLD in AAD decrease with age, both in type A and type B AAD. Type A AAD patients with FLD had onset with better air quality parameters compared with non-FLD group. FLD was associated with higher risk of in-hospital mortality in type B AAD.

P5607Clinical characteristics and treatment strategy for acute aortic dissection in Tokyo Acute Aortic Disease Super-Network System

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Yoshino ◽  
K Akutsu ◽  
T Takahashi ◽  
T Shimokawa ◽  
H Ogino ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Treatment Strategy ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Network System ◽  
Care Hospital ◽  
Type B ◽  
New System

Abstract Introduction Acute aortic dissection (AAD) is one of the most fatal cardiovascular diseases. The prevalence of AAD is reported to be low. The clinical data of AAD from representative cardiovascular centers are not enough to show the whole range of clinical feature of AAD. We have to know the exact prevalence and clinical pictures of AAD under the new system, the Tokyo AAD Super-Network System (TAAD-SNS), for strategy of emergency transport and treatment of AAD which would cover the entire metropolitan area of Tokyo. TAAD-SNS started in 2011, and after slight modification, the new system of AAD re-started in 2013. The aim of this study is to elucidate the whole range of clinical characteristics and recent trends of treatment of AAD. Methods Out of 73 hospitals included in Tokyo CCU Network system, 41 hospitals are chosen for TAAD-SNS. These hospitals provide around-the-clock surgery. In this system, the availability of surgical division is monitored in real time. All of the patients suspected of AAD are transferred directly or from primary care hospital to the hospitals of TAAD-SNS. Results After exclusion of 237 patients with cardiopulmonary arrest on arrival, 4877 consecutive patients (2923 male, mean age of 69±14 y/o) were admitted to the hospitals with diagnosis of AAD from 2013 to 2016. Prevalence of AAD in Tokyo was about 10 patients per 100,000 populations in every year. After exclusion of 37 patients undetermined into type A or B, 4840 patients (2694 with type A and 2146 with type B) were analyzed. Among the type A patients, 1752 (65%) were classified into type of patent false lumen (classic-type), 721 (27%) of closed false lumen (intramural hematoma: IMH-type), and 221 (8%) were undetermined. Among the type B, 880 (41%) were classified into classic-type, 1129 (53%) of IMH-type, and 137 (6%) were undetermined. Both among type A and B, mean ages were younger in classic-type than in IMH-type (type A: 66±14 vs. 73±12 y/o, p<0.05; type B: 64±15 vs. 72±12 y/o, p<0.05). Prevalence of male population and risk factor of hypertension was higher in type B than in type A both among classic-type and IMH-type. Systolic blood pressure at the emergency room was lower in type A than in type B among both classic-type and IMH-type (classic-type: 124±34 vs. 161±38 mmHg, IMH-type: 130±51 vs. 163±56 mmHg). In-hospital mortality of surgical treatment for type A classic-type and type A IMH-type, conservative strategy for type B classic-type and type B IMH-type was 9.6%, 4.2%, 3.1% and 1.7%, respectively. Stentgraft implantation for type B AAD started and shows a favorable in-hospital mortality compared to the operative treatment (Stentgraft vs. surgery in type B classic-type: 7.8% vs. 6.5%, in type B IMH-type: 10.7% vs. 11.8%, respectively). Conclusion Our study showed that prevalence of AAD was 2–3 times higher than previous reports. We should consider to choose the treatment strategy according to the type of AAD, A or B, classic-type or IMH-type. Acknowledgement/Funding Tokyo Metropolitan government

Incidence and risk factors of recurrent pain in acute aortic dissection and in-hospital mortality

VASA ◽  
2018 ◽  
Vol 47 (4) ◽  
pp. 301-310
Author(s):  
Dilixiati Siti ◽  
Asiya Abudesimu ◽  
Xiaojie Ma ◽  
Lei Yang ◽  
Xiang Ma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Acute Aortic Dissection ◽  
Emergency Operation ◽  
Type A ◽  
Type B ◽  
Recurrent Pain ◽  
Group I ◽  
Group Ii

Abstract. Background: We investigated the prevalence of recurrent pain and its relationship with in-hospital mortality in acute aortic dissection (AAD). Patients and methods: Between 2011 and 2016, 234 AAD patients were selected. Recurrent pain was defined as a mean of VAS > 3, within 48 hours following hospital admission or before emergency operation. Patients with and without recurrent pain were divided into group I and group II, respectively into type A AAD and type B AAD patients. Our primary outcome was in-hospital mortality. Results: The incidence of recurrent pain was 24.4 % in AAD patients. Incidence of recurrent pain was higher in type A AAD patients than type B AAD patients (48.9 vs. 9.6 %). Overall in-hospital mortality was 25.6 %. Type A AAD had a higher in-hospital mortality than type B AAD patients (47.7 vs. 12.3 %). Group I had significantly higher in-hospital mortality than group II (type A: 79.1 vs. 17.8 %; type B: 57.1 vs. 7.6 %, all P < 0.001), as was the case with medical managed patients (type A: 72.1 vs. 13.3 %; type B: 35.7 vs. 2.3 %, all P < 0.001). Logistic regression analysis showed that use of one drug alone and waist pain were predictive factors for recurrent pain in type A AAD and type A AAD patients, respectively (OR 3.686, 95 % CI: 1.103~12.316, P = 0.034 and OR 14.010, 95 % CI: 2.481~79.103, P = 0.003). Recurrent pains were the risk factors (type A: OR 11.096, 95 % CI: 3.057~40.280, P < 0.001; type B: OR 14.412, 95 % CI: 3.662~56.723, P < 0.001), while invasive interventions were protective (type A: OR 0.133, 95 % CI: 0.035~0.507, P < 0.001; type B: OR 0.334, 95 % CI: 0.120~0.929, P = 0.036) for in-hospital mortality in AAD patients. Conclusions: Approximately one-fourth of AAD patients presented with recurrent pains, which might increase in-hospital mortality. Thus, interventional strategies at early stages are important.

scholarly journals Impact of structural and process quality indicators on the outcomes of acute aortic dissection

2020 ◽  
Vol 58 (6) ◽  
pp. 1281-1288
Author(s):  
Tetsuo Yamaguchi ◽  
Michikazu Nakai ◽  
Yoko Sumita ◽  
Yoshihiro Miyamoto ◽  
Hitoshi Matsuda ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Quality Indicators ◽  
Real World ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Sensitivity Analyses ◽  
Administrative Database ◽  
Type B ◽  
Practice Gaps

Abstract OBJECTIVES The mortality of acute aortic dissection (AAD) remains high, and evidence-to-practice gaps exist in real-world treatment. We explored the first quality indicators (QIs) for AAD management and evaluated the associations between the achievement of these QIs and the outcome in a nationwide administrative database. METHODS A systematic search was performed to establish initial index items for QIs. An evaluation was performed through an expert consensus meeting using the Delphi method. We studied 18 348 patients who had AAD (type A: 10 131; type B: 8217) in the Japanese Registry of All Cardiac and Vascular Diseases database between April 2012 and May 2015. The associations between the achievement of QIs [categorized into tertiles (low, middle and high)] and in-hospital mortality were determined by multivariable mixed logistic regression analyses. RESULTS AND CONCLUSION We developed a total of 9 QIs (5 structural and 4 process). Lower achievement rates of QIs were significantly associated with higher in-hospital mortality in both types [type A = middle: odds ratio (OR) 4.03; 95% confidence interval (CI) 3.301–4.90; P &lt; 0.001; low: OR 15.68; 95% CI 11.67–21.06; P &lt; 0.001 vs high; type B = middle: OR 3.48; 95% CI 2.19–5.53; P &lt; 0.001; low: OR 7.79; 95% CI 4.65–13.06; P &lt; 0.001 vs high]. Various sensitivity analyses showed consistent results. High achievement rates of QIs were significantly associated with reduced in-hospital mortality. Evaluating each hospital’s management using QIs would help to equalize treatment quality and demonstrate the evidence-to-practice gaps in real-world treatments for AAD.

scholarly journals OPG/TRAIL ratio as a predictive biomarker of mortality in patients with type A acute aortic dissection

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Jie Lu ◽  
Ping Li ◽  
Ke Ma ◽  
Yang Li ◽  
Hui Yuan ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Strong Predictor ◽  
Type A ◽  
Short Term ◽  
Post Discharge ◽  
Cross Sectional ◽  
Derivation Cohort ◽  
Long Term Mortality

AbstractFollowing hospital discharge, patients with type A acute aortic dissection (TA-AAD) may present an increase in mortality risk. However, little is known about specific biomarkers associated with post-discharge survival, and there is a paucity of prognostic markers associated with TA-AAD. Here, we identify nine candidate proteins specific for patietns with TA-AAD in a cross-sectional dataset by unbiased protein screening and in-depth bioinformatic analyses. In addition, we explore their association with short-term and long-term mortality in a derivation cohort of patients with TA-AAD, including an internal (n = 300) and external (n = 236) dataset. An elevated osteoprotegerin (OPG)/tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) ratio was the strongest predictor of overall, 30-day, post-30-day mortality in both datasets and was confirmed to be a strong predictor of mortality in an independent validation cohort (n = 400). Based on OPG/TRAIL ratio-guided risk stratification, patients at high risk (>33) had a higher 1-year mortality (55.6% vs. 4.3%; 68.2% vs. 2.6%) than patients at low risk (<4) in both cohorts. In Conclusion, we show that an elevated OPG/TRAIL ratio is associated with a significant increase in short-term and long-term mortality in patients with TA-AAD.

scholarly journals U-shaped relationship between platelet–lymphocyte ratio and postoperative in-hospital mortality in patients with type A acute aortic dissection

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xi Xie ◽  
Xiangjie Fu ◽  
Yawen Zhang ◽  
Wanting Huang ◽  
Lingjin Huang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Acute Aortic Dissection ◽  
Inflammatory Marker ◽  
Smooth Curve ◽  
Type A ◽  
Independent Effect ◽  
Lymphocyte Ratio ◽  
Platelet Lymphocyte Ratio

Abstract Background The platelet-lymphocyte ratio (PLR), a novel inflammatory marker, is generally associated with increased in-hospital mortality risk. We aimed to investigate the association between PLR and postoperative in-hospital mortality risk in patients with type A acute aortic dissection (AAAD). Methods Patients (n = 270) who underwent emergency surgery for AAAD at Xiangya Hospital of Central South University between January 2014 and May 2019 were divided into three PLR-based tertiles. We used multiple regression analyses to evaluate the independent effect of PLR on in-hospital mortality, and smooth curve fitting and a segmented regression model with adjustment of confounding factors to analyze the threshold effect between PLR and in-hospital mortality risk. Results The overall postoperative in-hospital mortality was 13.33%. After adjusting for confounders, in-hospital mortality risk in the medium PLR tertile was the lowest (Odds ratio [OR] = 0.20, 95% confidence interval [CI] = 0.06–0.66). We observed a U-shaped relationship between PLR and in-hospital mortality risk after smoothing spline fitting was applied. When PLR < 108, the in-hospital mortality risk increased by 10% per unit decrease in PLR (OR = 0.90, P = 0.001). When the PLR was between 108 and 188, the mortality risk was the lowest (OR = 1.02, P = 0.288). When PLR > 188, the in-hospital mortality risk increased by 6% per unit increase in PLR (OR = 1.06, P = 0.045). Conclusions There was a U-shaped relationship between PLR and in-hospital mortality in patients with AAAD, with an optimal PLR range for the lowest in-hospital mortality risk of 108–188. PLR may be a useful preoperative prognostic tool for predicting in-hospital mortality risk in patients with AAAD and can ensure risk stratification and early treatment initiation.

scholarly journals Machine Learning Models for Predicting In-Hospital Mortality in Acute Aortic Dissection Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Tuo Guo ◽  
Zhuo Fang ◽  
Guifang Yang ◽  
Yang Zhou ◽  
Ning Ding ◽  
...  
Keyword(s):  
Machine Learning ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Receiver Operating Characteristic Curve ◽  
Operating Characteristic ◽  
Acute Aortic Dissection ◽  
Characteristic Curve ◽  
Survivor Group ◽  
Treatment Type ◽  
Operating Characteristic Curve

Background: Acute aortic dissection is a potentially fatal cardiovascular disorder associated with high mortality. However, current predictive models show a limited ability to efficiently and flexibly detect this mortality risk, and have been unable to discover a relationship between the mortality rate and certain variables. Thus, this study takes an artificial intelligence approach, whereby clinical data-driven machine learning was utilized to predict the in-hospital mortality of acute aortic dissection.Methods: Patients diagnosed with acute aortic dissection between January 2015 to December 2018 were voluntarily enrolled from the Second Xiangya Hospital of Central South University in the study. The diagnosis was defined by magnetic resonance angiography or computed tomography angiography, with an onset time of the symptoms being within 14 days. The analytical variables included demographic characteristics, physical examination, symptoms, clinical condition, laboratory results, and treatment strategies. The machine learning algorithms included logistic regression, decision tree, K nearest neighbor, Gaussian naive bayes, and extreme gradient boost (XGBoost). Evaluation of the predictive performance of the models was mainly achieved using the area under the receiver operating characteristic curve. SHapley Additive exPlanation was also implemented to interpret the final prediction model.Results: A total of 1,344 acute aortic dissection patients were recruited, including 1,071 (79.7%) patients in the survivor group and 273 (20.3%) patients in non-survivor group. The extreme gradient boost model was found to be the most effective model with the greatest area under the receiver operating characteristic curve (0.927, 95% CI: 0.860–0.968). The three most significant aspects of the extreme gradient boost importance matrix plot were treatment, type of acute aortic dissection, and ischemia-modified albumin levels. In the SHapley Additive exPlanation summary plot, medical treatment, type A acute aortic dissection, and higher ischemia-modified albumin level were shown to increase the risk of hospital-based mortality.

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