Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
Department of Clinical Laboratory, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China.
Sci Rep. 2021 Sep 21;11(1):18775. doi: 10.1038/s41598-021-98298-w.
The aim of this study was to analyze the role of blood biomarkers regarding preoperative inflammation and coagulation in predicting the postoperative in-hospital mortality of patients with type A acute aortic dissection (AAD). A total of 206 patients with type A AAD who had received surgical treatment were enrolled in this study. Patients were divided into two groups: the death group (28 patients who died during hospitalization) and the survival group (178 patients). Peripheral blood samples were collected before anesthesia induction. Preoperative levels of D-dimer, fibrinogen (FIB), platelet (PLT), white blood cells (WBC) and neutrophil (NEU) were compared between the two groups. Univariable and multivariable logistic regression analysis were utilized to identify the independent risk factors for postoperative in-hospital deaths of patients with type A AAD. Receiver operating characteristic (ROC) curve were used to analyze the predictive value of these indices in the postoperative in-hospital mortality of the patients. Univariable logistic regression analysis showed that the P values of the five parameters including D-dimer, FIB, PLT, WBC and NEU were all less than 0.1, which may be risk factors for postoperative in-hospital deaths of patients with type A AAD. Further multivariable logistic regression analysis indicated that higher preoperative D-dimer and WBC levels were independent risk factors for postoperative in-hospital mortality of patients with type A AAD. ROC curve analysis indicated that application of combining FIB and PLT could improve accuracy in prediction of postoperative in-hospital mortality in patients with type A AAD. Both preoperative D-dimer and WBC in patients with type A AAD may be used as independent risk factors for the postoperative in-hospital mortality of such patients. The combination of FIB and PLT may improve the accuracy of clinical prognostic assessment.
本研究旨在分析术前炎症和凝血的血液生物标志物在预测急性 A 型主动脉夹层 (AAD) 患者术后住院内死亡率中的作用。共纳入 206 例接受手术治疗的 A 型 AAD 患者。将患者分为两组：死亡组（28 例住院期间死亡患者）和存活组（178 例）。在麻醉诱导前采集外周血样本。比较两组患者术前 D-二聚体、纤维蛋白原 (FIB)、血小板 (PLT)、白细胞 (WBC) 和中性粒细胞 (NEU) 水平。采用单变量和多变量逻辑回归分析确定 A 型 AAD 患者术后住院内死亡的独立危险因素。使用受试者工作特征 (ROC) 曲线分析这些指标对患者术后住院内死亡率的预测价值。单变量逻辑回归分析显示，D-二聚体、FIB、PLT、WBC 和 NEU 这五个参数的 P 值均小于 0.1，可能是 A 型 AAD 患者术后住院内死亡的危险因素。进一步多变量逻辑回归分析表明，术前 D-二聚体和 WBC 水平较高是 A 型 AAD 患者术后住院内死亡的独立危险因素。ROC 曲线分析表明，联合 FIB 和 PLT 的应用可提高 A 型 AAD 患者术后住院内死亡率预测的准确性。A 型 AAD 患者的术前 D-二聚体和 WBC 均可作为此类患者术后住院内死亡率的独立危险因素。FIB 和 PLT 的联合应用可能提高临床预后评估的准确性。
