From the Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy (J.L.T., V.R., S.T.); Department of Vascular Surgery; University Medical Center Utrecht, Utrecht, The Netherlands (J.L.T., F.H.W.J.); Department of Internal Medicine, University of Michigan, Ann Arbor (W.F., D.M., K.A.E.); Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville (G.R.U.); Department of Cardiology, University of Colorado Hospital, Aurora (T.T.T.); Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Cardiology Department, Brigham & Women's Hospital, Boston, MA (P.O.); Cardiovascular Medicine, University of Massachusetts Hospital, Worcester (L.P.); Thoracic Aortic Center, Massachusetts General Hospital, Boston (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
Circulation. 2014 Sep 9;130(11 Suppl 1):S45-50. doi: 10.1161/CIRCULATIONAHA.113.007117.
The outcome of patients with acute type B aortic dissection (ABAD) is strongly related to their clinical presentation. The purpose of this study was to investigate predictors for mortality among patients presenting with ABAD and to create a predictive model to estimate individual risk of in-hospital mortality using the International Registry of Acute Aortic Dissection (IRAD).
All patients with ABAD enrolled in IRAD between 1996 and 2013 were included for analysis. Multivariable logistic regression analysis was used to investigate predictors of in-hospital mortality. Significant risk factors for in-hospital death were used to develop a prediction model. A total of 1034 patients with ABAD were included for analysis (673 men; mean age, 63.5±14.0 years), with an overall in-hospital mortality of 10.6%. In multivariable analysis, the following variables at admission were independently associated with increased in-hospital mortality: increasing age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00-1.06; P=0.044), hypotension/shock (OR, 6.43; 95% CI, 2.88-18.98; P=0.001), periaortic hematoma (OR, 3.06; 95% CI, 1.38-6.78; P=0.006), descending diameter ≥5.5 cm (OR, 6.04; 95% CI, 2.87-12.73; P<0.001), mesenteric ischemia (OR, 9.03; 95% CI, 3.49-23.38; P<0.001), acute renal failure (OR, 3.61; 95% CI, 1.68-7.75; P=0.001), and limb ischemia (OR, 3.02; 95% CI, 1.05-8.68; P=0.040). Based on these multivariable results, a reliable and simple bedside risk prediction tool was developed.
We present a simple prediction model using variables that are independently associated with in-hospital mortality in patients with ABAD. Although it needs to be validated in an independent population, this model could be used to assist physicians in their choice of management and for informing patients and their families.
急性 B 型主动脉夹层（ABAD）患者的预后与临床表现密切相关。本研究旨在探讨 ABAD 患者死亡的预测因素，并利用国际急性主动脉夹层注册研究（IRAD）建立预测模型，以估计个体院内死亡率的风险。
纳入 1996 年至 2013 年期间 IRAD 登记的所有 ABAD 患者进行分析。采用多变量逻辑回归分析探讨院内死亡的预测因素。利用显著的院内死亡危险因素建立预测模型。共纳入 1034 例 ABAD 患者进行分析（673 例男性；平均年龄 63.5±14.0 岁），总体院内死亡率为 10.6%。多变量分析显示，入院时以下变量与院内死亡率增加相关：年龄增长（比值比 [OR]，1.03；95%置信区间 [CI]，1.00-1.06；P=0.044）、低血压/休克（OR，6.43；95%CI，2.88-18.98；P=0.001）、主动脉旁血肿（OR，3.06；95%CI，1.38-6.78；P=0.006）、降主动脉直径≥5.5cm（OR，6.04；95%CI，2.87-12.73；P<0.001）、肠系膜缺血（OR，9.03；95%CI，3.49-23.38；P<0.001）、急性肾衰竭（OR，3.61；95%CI，1.68-7.75；P=0.001）和肢体缺血（OR，3.02；95%CI，1.05-8.68；P=0.040）。基于这些多变量结果，开发了一种可靠且简单的床边风险预测工具。
我们提出了一种使用与 ABAD 患者院内死亡率独立相关的变量的简单预测模型。尽管需要在独立人群中进行验证，但该模型可用于协助医生进行治疗选择，并为患者及其家属提供信息。
