Xie Linfeng, He Jian, Lin Xinfan, Zhang Zhaofeng, Zhuang Xinghui, Jiang Debin
Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China.
Front Cardiovasc Med. 2023 Oct 9;10:1210725. doi: 10.3389/fcvm.2023.1210725. eCollection 2023.
The aim of this study was to identify the predictive factors for adverse clinical events after surgery in patients with acute type A aortic dissection (AAAD), and to explore the predictive value of preoperative prognostic nutritional index (PNI) combined with D-dimer for these events.
This study was a retrospective analysis of clinical data of 153 patients with AAAD who underwent emergency surgery at our center from January 2019 to January 2022. Patients were divided into adverse event group and non-adverse event group based on whether they experienced adverse clinical events after surgery. Univariate and multivariable logistic regression analyses were performed to identify the risk factors for adverse events, and the predictive efficacy was evaluated by the area under the receiver operating characteristic curve (ROC-AUC).
A total of 153 AAAD patients were included in the study, and were divided into the adverse event group ( = 46) and the non-adverse events group ( = 107) based on whether or not they experienced clinical adverse events after surgery. The optimal cutoff value was determined using ROC curves, and multivariate logistic regression analysis was performed. Ultimately, it was found that preoperative PNI < 42.45 and D-dimer > 15.05 were independent predictors of postoperative clinical adverse events in AAAD patients. The odd ratios (OR) value for preoperative PNI < 42.45 is 3.596 [95% Confidence Interval (CI): 1.508-8.923, = 0.004], while the OR value for D-dimer > 15.05 is 7.572 [95% CI: 3.094-20.220, < 0.001]. The combination of these two indicators has a high predictive value (AUC = 0.843, 95% CI: 0.774-0.912, < 0.001) and is superior to using either variable alone.
Preoperative PNI < 42.45 and D-dimer > 15.05 are independent predictive factors for postoperative adverse events during hospitalization in patients with AAAD. The combination of these two indicators can improve the predictive accuracy, which is superior to using either variable alone.
本研究旨在确定急性A型主动脉夹层（AAAD）患者术后不良临床事件的预测因素，并探讨术前预后营养指数（PNI）联合D-二聚体对这些事件的预测价值。
本研究对2019年1月至2022年1月在我院中心接受急诊手术的153例AAAD患者的临床资料进行回顾性分析。根据患者术后是否发生不良临床事件，将其分为不良事件组和非不良事件组。采用单因素和多因素logistic回归分析确定不良事件的危险因素，并通过受试者工作特征曲线下面积（ROC-AUC）评估预测效能。
本研究共纳入153例AAAD患者，根据术后是否发生临床不良事件分为不良事件组（n = 46）和非不良事件组（n = 107）。利用ROC曲线确定最佳截断值，并进行多因素logistic回归分析。最终发现，术前PNI < 42.45和D-二聚体 > 15.05是AAAD患者术后临床不良事件的独立预测因素。术前PNI < 42.45的比值比（OR）值为3.596 [95%置信区间（CI）：1.508 - 8.923，P = 0.004]，而D-二聚体 > 15.05的OR值为7.572 [95% CI：3.094 - 20.220，P < 0.001]。这两个指标的联合具有较高的预测价值（AUC = 0.843，95% CI：0.774 - 0.912，P < 0.001），且优于单独使用任何一个变量。
术前PNI < 42.45和D-二聚体 > 15.05是AAAD患者住院期间术后不良事件的独立预测因素。这两个指标的联合可提高预测准确性，优于单独使用任何一个变量。
