全身免疫炎症指数可预测接受最佳药物治疗的急性非复杂性 B 型主动脉夹层患者的临床结局。
Systemic immune-inflammation index predicts the clinical outcomes in patients with acute uncomplicated type-B aortic dissection undergoing optimal medical therapy.
机构信息
Department of Anesthesiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
出版信息
BMC Cardiovasc Disord. 2024 Jan 2;24(1):7. doi: 10.1186/s12872-023-03596-y.
BACKGROUND
Optimal medical therapy (OMT) for uncomplicated type B aortic dissection (uTBAD) provides excellent short-term outcomes during follow up; however, its long-term therapeutic effectiveness is unsatisfactory. This study evaluated the predictive value of systemic immune-inflammation index (SII) for adverse events among patients with acute uTBAD undergoing OMT.
METHODS
We performed a retrospective analysis of a prospectively maintained database between 2013 and 2020. The primary end point in this study was composite outcomes including aortic intervention, all-cause mortality, retrograde type A aortic dissection (rTAAD) and aortic diameter growth > 5 mm. The patients were divided into high and low SII groups according to the optimal cut-off value of SII as determined using the receiver operating characteristic curve. Cox proportional hazards models were constructed to estimate the hazards ratios and identify the predictors of composite outcomes.
RESULTS
A total of 124 patients with acute uTBAD who underwent OMT were enrolled. One patient died during hospitalisation. At the end of a mean follow-up duration of 51 ± 23 months, 53 (43.1%) patients experienced composite outcomes, 15 patients (12.2%) died, 31 (25.2%) underwent aortic intervention, 21 (17.1%) exhibited diameter growth of > 5 mm, and 2 developed rTAAD. The patients were divided into low SII group (n = 78, 62.9%) and high SII group (n = 46, 37.1%) as per the optimal cut-off SII value of 1449. The incidence of composite outcomes in high SII group was significantly higher than that in low SII (28 [60.9%] vs. 26[33.3%], p < 0.01). Patients with high SII demonstrated significantly higher mortality rate than those with a low SII (11 [23.9%] vs. 5 [6.4%], respectively; p < 0.01). In addition, the high SII group had significantly higher rate of aortic-related reinterventions than the low SII group (16 [34.8%] vs. 15 [19.2%], p = 0.03). Multivariable Cox analyses showed that a high SII score was independently associated with composite outcomes rate (hazard ratio, 2.15; 95% confidence interval, 1.22-3.78; p < 0.01).
CONCLUSIONS
The long-term therapeutic effectiveness of OMT alone in patients with acute uTBAD is unsatisfactory. An SII > 1449 at the time of diagnosis is an independent predictor of OMT failure.
背景
对于未破裂型胸主动脉夹层（uTBAD）患者，最佳药物治疗（OMT）在随访期间提供了极好的短期结果；然而，其长期治疗效果并不令人满意。本研究评估了全身免疫炎症指数（SII）对接受 OMT 的急性 uTBAD 患者不良事件的预测价值。
方法
我们对 2013 年至 2020 年期间前瞻性维护的数据库进行了回顾性分析。本研究的主要终点是包括主动脉介入、全因死亡率、逆行性胸主动脉夹层（rTAAD）和主动脉直径生长超过 5mm 的复合结局。根据 SII 的最佳截断值（使用受试者工作特征曲线确定），将患者分为高 SII 组和低 SII 组。使用 Cox 比例风险模型来估计风险比并确定复合结局的预测因素。
结果
共纳入 124 例接受 OMT 的急性 uTBAD 患者，1 例患者在住院期间死亡。在平均 51±23 个月的随访结束时，53 例（43.1%）患者发生复合结局，15 例（12.2%）死亡，31 例（25.2%）接受主动脉介入，21 例（17.1%）出现直径生长超过 5mm，2 例发生 rTAAD。根据 SII 的最佳截断值 1449，患者被分为低 SII 组（n=78，62.9%）和高 SII 组（n=46，37.1%）。高 SII 组的复合结局发生率明显高于低 SII 组（28[60.9%]比 26[33.3%]，p<0.01）。高 SII 组的死亡率明显高于低 SII 组（11[23.9%]比 5[6.4%]，p<0.01）。此外，高 SII 组主动脉相关再干预的发生率明显高于低 SII 组（16[34.8%]比 15[19.2%]，p=0.03）。多变量 Cox 分析显示，高 SII 评分与复合结局发生率独立相关（危险比，2.15；95%置信区间，1.22-3.78；p<0.01）。
结论
对于急性 uTBAD 患者，单独进行 OMT 的长期治疗效果并不令人满意。诊断时 SII>1449 是 OMT 失败的独立预测因素。
Zotero 插件