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临床与计算机断层扫描结果联合评估在急性主动脉夹层中的长期预后价值

Long-term prognostic value of the combined assessment of clinical and computed tomography findings in type: An acute aortic dissection.

作者信息

Hirata Kenichiro, Oda Seitaro, Suzuki Ryusuke, Sugahara Takeshi

机构信息

Department of Radiology, Kumamoto Red-Cross Hospital.

Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University.

出版信息

Medicine (Baltimore). 2020 Nov 6;99(45):e23008. doi: 10.1097/MD.0000000000023008.

Abstract

Type A acute aortic dissection (TAAAD) carries a high mortality rate in the absence of surgical treatment. This study sought to determine whether combining the assessment of clinical and computed tomography (CT) findings can be used to predict the long-term all-cause mortality rate of patients with TAAAD.Eighty-five consecutive patients with TAAAD who had undergone CT imaging and surgery were retrospectively reviewed. For the clinical and CT findings, univariate testing followed by multivariate logistic regression analysis was conducted to identify independent predictors of death. Then, the area under the receiver operating characteristic curve of the combined prediction model was calculated.The long-term mortality rate was 34.1% in our cohort (a median follow-up period of 60 months). Multivariate logistic regression analysis identified the following presenting variables as predictors of death: male sex (odds ratio [OR]: 6.67; 95% confidence interval [CI]: 1.67-25.0; P = .007), kidney malperfusion (OR: 2.18; 95% CI: 1.16-4.1; P = .02), and descending aorta size (OR: 1.12; 95% CI: 1.00-1.25; P = .05). Receiver operating characteristic curve analysis revealed an area under the receiver operating characteristic curve of 0.84 when using the combined model for prediction of long-term all-cause mortality (P ≤ .01).The combined assessment of clinical and CT findings can reasonably predict the long-term prognosis of TAAAD with surgery.

摘要

在未进行手术治疗的情况下,A型急性主动脉夹层(TAAAD)的死亡率很高。本研究旨在确定结合临床评估和计算机断层扫描(CT)结果是否可用于预测TAAAD患者的长期全因死亡率。对85例连续接受CT成像和手术的TAAAD患者进行了回顾性研究。对于临床和CT结果,先进行单变量检验,然后进行多变量逻辑回归分析,以确定死亡的独立预测因素。然后,计算联合预测模型的受试者工作特征曲线下面积。我们队列中的长期死亡率为34.1%(中位随访期为60个月)。多变量逻辑回归分析确定以下呈现变量为死亡预测因素:男性(比值比[OR]:6.67;95%置信区间[CI]:1.67 - 25.0;P = 0.007)、肾脏灌注不良(OR:2.18;95%CI:1.16 - 4.1;P = 0.02)和降主动脉大小(OR:1.12;95%CI:1.00 - 1.25;P = 0.05)。受试者工作特征曲线分析显示,使用联合模型预测长期全因死亡率时,受试者工作特征曲线下面积为0.84(P≤0.01)。临床和CT结果的联合评估可以合理地预测接受手术的TAAAD患者的长期预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7d54/7647554/f91ac0cb469f/medi-99-e23008-g001.jpg

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