Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, China.
Trauma Center of Hunan Province, Changsha, China.
Sci Rep. 2024 Oct 27;14(1):25595. doi: 10.1038/s41598-024-77649-3.
Currently, evidence concerning the link between maximal aortic diameter and in-hospital mortality in cases of acute type B aortic dissection (ATBAD) is insufficient. Thus, this study aimed to explore the relationship between the maximal aortic diameter at the time of admission and the early prognosis of patients diagnosed with ATBAD. A total of 678 patients with ATBAD were included between January 2016 and December 2018, during which their clinical data was gathered. The independent variable analyzed was the maximal diameter of the aorta, while the dependent variable was mortality during hospitalization. Factors considered in this analysis included the patients' age, gender, body mass index (BMI), medical history of hypertension, stroke, diabetes, atherosclerosis, smoking habits, chronic kidney insufficiency, time until presentation, systolic and diastolic blood pressures, ejection fraction, presence of aortic regurgitation, symptoms, involvement of abdominal vessels, laboratory findings, and treatment approaches. Of these patients collected, the mean age was 56.03 ± 12.22 years, and approximately 82.45% of them were male. After analysis, it was found that the maximal aortic diameter of patients with ATBAD was positively correlated with in-hospital mortality (OR = 1.06, 95% CI 1.03 to 1.10). Surprisingly, a J curve relationship was detected between maximal aortic diameter (point 31 mm) and in-hospital death for patients with ATBAD. The effect sizes and confidence intervals of the right (maximal aortic diameter > 31 mm) and left (maximal aortic diameter ≤ 31 mm) aspects of the inflection point were 1.06 (1.02-1.11) and 1.03 (0.83-1.28), respectively. In addition, the stratified analysis showed a stable relationship between maximal aortic diameter and in-hospital mortality, while there was no significant difference in the interaction between different subgroups. In patients with ATBAD, a J-curve relationship was identified between the maximal aortic diameter and in-hospital mortality. Specifically, when the maximal aortic diameter exceeds 31 mm, a positive correlation with in-hospital death was observed.
目前，关于急性 B 型主动脉夹层（ATBAD）最大主动脉直径与院内死亡率之间的关系的证据还不够充分。因此，本研究旨在探讨入院时最大主动脉直径与 ATBAD 患者早期预后之间的关系。2016 年 1 月至 2018 年 12 月期间，共纳入 678 例 ATBAD 患者，收集其临床资料。分析的自变量为主动脉最大直径，因变量为住院期间死亡率。本分析考虑的因素包括患者年龄、性别、体重指数（BMI）、高血压、中风、糖尿病、动脉粥样硬化、吸烟习惯、慢性肾功能不全、就诊时间、收缩压和舒张压、射血分数、主动脉瓣反流、症状、腹部血管受累、实验室检查和治疗方法。在这些收集的患者中，平均年龄为 56.03±12.22 岁，约 82.45%为男性。分析后发现，ATBAD 患者的最大主动脉直径与院内死亡率呈正相关（OR=1.06，95%CI 1.03-1.10）。令人惊讶的是，ATBAD 患者的最大主动脉直径与院内死亡之间存在 J 型关系。拐点右侧（最大主动脉直径>31mm）和左侧（最大主动脉直径≤31mm）的效应大小和置信区间分别为 1.06（1.02-1.11）和 1.03（0.83-1.28）。此外，分层分析显示，最大主动脉直径与院内死亡率之间存在稳定的关系，而不同亚组之间的交互作用无显著差异。在 ATBAD 患者中，最大主动脉直径与院内死亡率之间存在 J 型关系。具体来说，当最大主动脉直径超过 31mm 时，与院内死亡呈正相关。
