Zhou Qin, Chai Xiang-Ping, Fang Zhen-Fei, Hu Xin-Qun, Tang Liang
Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
Chin Med J (Engl). 2016 Nov 5;129(21):2589-2595. doi: 10.4103/0366-6999.192785.
Acute aortic dissection is a life-threatening cardiovascular emergency. Pentraxin-3 (PTX3) is proposed as a prognostic marker and found to be related to worse clinical outcomes in various cardiovascular diseases. This study sought to investigate the association of circulating PTX3 levels with in-hospital mortality in patients with acute Type A aortic dissection (TAAD).
A total of 98 patients with TAAD between January 2012 and December 2015 were enrolled in this study. Plasma concentrations of PTX3 were measured upon admission using a high-sensitivity enzyme-linked immunosorbent assay system. Patients were divided into two groups as patients died during hospitalization (Group 1) and those who survived (Group 2). The clinical, laboratory variables, and imaging findings were analyzed between the two groups, and predictors for in-hospital mortality were evaluated using multivariate analysis.
During the hospital stay, 32 (33%) patients died and 66 (67%) survived. The patients who died during hospitalization had significantly higher PTX3 levels on admission compared to those who survived. Pearson's correlation analysis demonstrated that PTX3 correlated positively with high-sensitivity C-reactive protein (hsCRP), maximum white blood cell count, and aortic diameter. Multivariate logistic regression analysis demonstrated that PTX3 levels, coronary involvement, cardiac tamponade, and a conservative treatment strategy are significant independent predictors of in-hospital mortality in patients with TAAD. The receiver operating characteristic curve analysis further illustrated that PTX3 levels on admission were strong predictors of mortality with an area under the curve of 0.89. A PTX3 level ≥5.46 ng/ml showed a sensitivity of 88% and a specificity of 79%, and an hsCRP concentration ≥9.5 mg/L had a sensitivity of 80% and a specificity of 69% for predicting in-hospital mortality.
High PTX3 levels on admission are independently associated with the in-hospital mortality in patients with TAAD.
急性主动脉夹层是一种危及生命的心血管急症。五聚体-3（PTX3）被提议作为一种预后标志物，并被发现与各种心血管疾病的不良临床结局相关。本研究旨在探讨急性A型主动脉夹层（TAAD）患者循环PTX3水平与住院死亡率之间的关联。
本研究纳入了2012年1月至2015年12月期间共98例TAAD患者。入院时使用高灵敏度酶联免疫吸附测定系统测量PTX3的血浆浓度。患者分为两组，即住院期间死亡的患者（第1组）和存活的患者（第2组）。分析两组之间的临床、实验室变量和影像学结果，并使用多变量分析评估住院死亡率的预测因素。
住院期间，32例（33%）患者死亡，66例（67%）存活。与存活患者相比，住院期间死亡的患者入院时PTX3水平显著更高。Pearson相关性分析表明，PTX3与高灵敏度C反应蛋白（hsCRP）、最高白细胞计数和主动脉直径呈正相关。多变量逻辑回归分析表明，PTX3水平、冠状动脉受累、心脏压塞和保守治疗策略是TAAD患者住院死亡率的显著独立预测因素。受试者工作特征曲线分析进一步表明，入院时PTX3水平是死亡率的强预测因素，曲线下面积为0.89。PTX3水平≥5.46 ng/ml时，预测住院死亡率的灵敏度为88%，特异性为79%；hsCRP浓度≥9.5 mg/L时，灵敏度为80%，特异性为69%。
入院时PTX3水平高与TAAD患者的住院死亡率独立相关。
