Xie Linfeng, Lin Xinfan, Xie Yuling, Luo Siying, Wu Qingsong, Zhang Zhaofeng, Qiu Zhihuang, Chen Liangwan
Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China.
J Endovasc Ther. 2024 Dec 20:15266028241305953. doi: 10.1177/15266028241305953.
The aim of this study is to explore the value of different systemic inflammatory response indicators in the long-term prognosis of type B aortic dissection (TBAD) patients undergoing thoracic endovascular aortic repair (TEVAR).
This study retrospectively reviewed the case data of 540 patients with TBAD at our center from January 2013 to January 2019. Based on the occurrence of aorta-related adverse events (ARAEs) during follow-up, patients were divided into two groups: the ARAEs group and the non-ARAEs group. Univariate and multivariate analyses identified preoperative systemic inflammatory response index (SIRI) and C-reactive protein-to-albumin ratio (CAR) as independent risk factors for ARAEs. The SIRI-CAR score was then developed using these indicators. Receiver operating characteristic (ROC) curve analysis was employed to determine the optimal thresholds for SIRI and CAR in predicting ARAEs, then allowing for the classification of patients into high and low groups. Kaplan-Meier survival curves were used to compare survival status among patients with different SIRI, CAR, and SIRI-CAR score during follow-up, while cumulative hazard curves were used to assess the risk of various types of ARAEs among patients with differing SIRI-CAR scores.
In this study, 127 patients experienced ARAEs during follow-up. Univariate and multivariate analyses identified preoperative SIRI and CAR as independent risk factors for ARAEs. ROC curve analysis showed that the SIRI-CAR score provided superior predictive value for ARAEs compared to using SIRI and CAR separately. Kaplan-Meier survival curves revealed significantly lower ARAE-free survival rates in patients with high SIRI, high CAR, and high SIRI-CAR scores during follow-up. Additionally, cumulative hazard curves highlighted significant differences in the risk of various ARAEs among patients with different SIRI-CAR score, with the risk increasing as the score rose.
Preoperative SIRI and CAR are associated with the long-term prognosis of TBAD patients undergoing TEVAR, demonstrating good prognostic value. Additionally, the SIRI-CAR score, which combines both indicators, can more effectively predict the risk of long-term ARAEs.
This study provides valuable insights into the role of systemic inflammatory response indicators in predicting the long-term prognosis of TBAD patients undergoing TEVAR). By identifying key inflammatory biological indicators, clinicians can better stratify risk, personalize treatment, and monitor post-operative recovery more effectively. The incorporation of these indicators into clinical practice could enhance early intervention strategies, improve patient outcomes, and potentially reduce complications. The innovation lies in the focus on inflammatory responses, offering a novel prognostic tool to guide management decisions for these high-risk patients.
本研究旨在探讨不同全身炎症反应指标在接受胸主动脉腔内修复术（TEVAR）的B型主动脉夹层（TBAD）患者长期预后中的价值。
本研究回顾性分析了2013年1月至2019年1月在我院中心接受治疗的540例TBAD患者的病例资料。根据随访期间主动脉相关不良事件（ARAEs）的发生情况，将患者分为两组：ARAEs组和非ARAEs组。单因素和多因素分析确定术前全身炎症反应指数（SIRI）和C反应蛋白与白蛋白比值（CAR）为ARAEs的独立危险因素。然后使用这些指标建立SIRI-CAR评分。采用受试者工作特征（ROC）曲线分析确定SIRI和CAR预测ARAEs的最佳阈值，从而将患者分为高危组和低危组。采用Kaplan-Meier生存曲线比较随访期间不同SIRI、CAR和SIRI-CAR评分患者的生存状况，同时采用累积风险曲线评估不同SIRI-CAR评分患者发生各种ARAEs的风险。
在本研究中，127例患者在随访期间发生了ARAEs。单因素和多因素分析确定术前SIRI和CAR为ARAEs的独立危险因素。ROC曲线分析表明，与单独使用SIRI和CAR相比，SIRI-CAR评分对ARAEs具有更好的预测价值。Kaplan-Meier生存曲线显示，随访期间SIRI高、CAR高和SIRI-CAR评分高的患者无ARAEs生存率显著降低。此外，累积风险曲线突出显示了不同SIRI-CAR评分患者发生各种ARAEs的风险存在显著差异，且风险随评分升高而增加。
术前SIRI和CAR与接受TEVAR的TBAD患者的长期预后相关，具有良好的预后价值。此外，结合这两个指标的SIRI-CAR评分可以更有效地预测长期ARAEs的风险。
本研究为全身炎症反应指标在预测接受TEVAR的TBAD患者长期预后中的作用提供了有价值的见解。通过识别关键的炎症生物学指标，临床医生可以更好地进行风险分层。个性化治疗，并更有效地监测术后恢复情况。将这些指标纳入临床实践可以加强早期干预策略，改善患者预后，并可能减少并发症。本研究的创新之处在于关注炎症反应，为指导这些高危患者的管理决策提供了一种新的预后工具。
