Zhang Yuhui, Chen Tongyun, Chen Qingliang, Min Hou, Nan Jiang, Guo Zhigang
Clinial College of Chest, Tianjin Medical University, Tianjin, China.
Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China.
Ann Transl Med. 2021 Sep;9(18):1442. doi: 10.21037/atm-21-4063.
The purpose of the study was to assess the relationship between preoperative laboratory examination, clinical imaging data, and postoperative death of patients with acute type A aortic dissection (ATAAD) and to establish a prediction model of hospital death risk after the operation.
A total of 224 cases of acute Standford A aortic dissection were treated by total arch replacement using a tetrafurcate graft with stented elephant trunk implantation in Tianjin Chest Hospital. Based on preoperative laboratory examination and clinical imaging data of patients with ATAAD, the independent risk factors of postoperative hospital death were obtained using logistic analysis, and a risk prediction model of postoperative hospital death was developed.
Independent risk factors of postoperative death in patients with ATAAD were: body mass index (BMI), preoperative neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV), creatinine (Cr), D-dimer, high-sensitive cardiac troponin T (hs-CTnT), apolipoprotein A1, left subclavian artery involvement, and iliac artery involvement. The regression equation of postoperative death risk was: logitP1 = -9.584 + 1.060 × NLR + 1.586 × MPV + 1.009 × Cr + 1.067 × D-dimer + 2.023 × hs-CTnT; the regression equation of postoperative death risk was: logitP2 = -3.296 + 3.242 × left subclavian artery involved + 4.564 × iliac artery involved; the regression equation of postoperative death risk was: logitP3 = -12.864 + 1.149 × BMI + 4.731 × left subclavian artery involved + 4.150 × iliac artery involved + 1.064 × NLR + 1.011 × Cr + 1.084 × D-dimer + 2.242 × hs-CTnT + 3.233 × apolipoprotein A1.
BMI, NLR, MPV, Cr, D-dimer, hs-CTnT, apolipoprotein A1, left subclavian artery involvement and iliac artery involvement can affect the hospital mortality rate of aortic dissection undergoing Sun's operation to varying degrees, which may be helpful to guide the design of the perioperative treatment strategy.
本研究旨在评估急性A型主动脉夹层（ATAAD）患者术前实验室检查、临床影像数据与术后死亡之间的关系，并建立术后医院死亡风险预测模型。
天津胸科医院共224例急性Stanford A型主动脉夹层患者接受了带分支支架象鼻人工血管全弓置换术。基于ATAAD患者的术前实验室检查和临床影像数据，采用逻辑回归分析得出术后医院死亡的独立危险因素，并建立术后医院死亡风险预测模型。
ATAAD患者术后死亡的独立危险因素为：体重指数（BMI）、术前中性粒细胞与淋巴细胞比值（NLR）、平均血小板体积（MPV）、肌酐（Cr）、D-二聚体、高敏心肌肌钙蛋白T（hs-CTnT）、载脂蛋白A1、左锁骨下动脉受累及髂动脉受累。术后死亡风险回归方程为：logitP1 = -9.584 + 1.060×NLR + 1.586×MPV + 1.009×Cr + 1.067×D-二聚体 + 2.023×hs-CTnT；术后死亡风险回归方程为：logitP2 = -3.296 + 3.242×左锁骨下动脉受累 + 4.564×髂动脉受累；术后死亡风险回归方程为：logitP3 = -12.864 + 1.149×BMI + 4.731×左锁骨下动脉受累 + 4.150×髂动脉受累 + 1.064×NLR + 1.011×Cr + 1.084×D-二聚体 + 2.242×hs-CTnT + 3.233×载脂蛋白A1。
BMI、NLR、MPV、Cr、D-二聚体、hs-CTnT、载脂蛋白A1、左锁骨下动脉受累及髂动脉受累可不同程度地影响孙氏手术治疗主动脉夹层的医院死亡率，这可能有助于指导围手术期治疗策略的制定。
