Factors related to white blood cell elevation in acute type A aortic dissection

Abstract

Aortic dissection may induce a systemic inflammatory reaction. The etiological backgrounds for elevation of the white blood cell count remain to be clarified. In 466 patients with acute type A aortic dissection treated surgically within 48 hours of symptom onset, the etiologic background of an elevated admission white blood cell count and the effect of such elevation on outcomes were assessed retrospectively. Patients' white blood cell count differed significantly in relation to the extent of dissection, with a median (25th, 75th percentile) white blood cell count of 10.4 (8.1, 13.9) x 10 3 /μL for dissection confined to the ascending aorta, 10.5 (8.2,13.) 10 3 /μL for dissection extending to the aortic arch/descending aorta, 11.1 (8.2, 13.7) x 10 3 /μL for extension to the abdominal aorta, and 13.3 (9.8, 15.9) x 10 3 /μL for extension to the iliac artery (p<0.001). With 11.0 x 10 3/ μL used as the cutoff value for white blood cell count elevation, multivariable analysis showed current smoking (p<0.001; odds ratio, 2.79), dissection extending to the iliac artery (p = 0.006; odds ratio, 1.79), age (p = 0.007, odds ratio, 0.98), and no coronary ischemia (p = 0.027, odds ratio, 2.22) to be factors related to the elevated white blood cell count. Mean age differed significantly between patients with and without an elevated white blood cell count (62.3 vs. 68.3 years, p <0.001). Although inhospital mortality was similar (7.5% vs.10.9%, p = 0.19), 5-year survival was lower in patients without an elevated count (85.7% vs. 78.6%, p = 0.019), reflecting their more advanced age. In conclusion, our data suggest that dissection morphology and patient age influence the acute phase systemic inflammatory response associated with an elevated white blood cell count in patients with ATAAD. A better understanding of this relation may help optimize diagnosis and perioperative care.

SERPINE1 Gene Is a Reliable Molecular Marker for the Early Diagnosis of Aortic Dissection

“…The initial assessment and diagnosis of AD by routine examination is not easy at present, the misdiagnosis rate is high, and routine laboratory tests have no specific significance for the diagnosis of aortic coarctation and can only be used to exclude other diagnostic possibilities [ 37 ]. Occasionally, the acute onset of aortic coarctation may be associated with stress-related leukocytosis or anemia due to severe bleeding and massive blood flow into the false lumen, with individual diffuse intravascular coagulation [ 38 ]. Serum aminotransferases are generally not elevated unless myocardial infarction occurs with involvement of the coronary artery by a clotted hematoma [ 39 ].…”

Development and Validation of a Risk Prediction Model for Postoperative Pneumonia in Adult Patients Undergoing Stanford Type a Acute Aortic Dissection Surgery: A Case Control Study

“…An elevated white blood cell count has been observed in patients with aortic dissection in previous studies and was associated with adverse events [5,8]. The elevation of the white blood cell count may associate with the acute phase systemic in ammatory response [14].…”

A new diagnostic strategy with neutrophil counts in patients with suspected aortic dissection in a certain time window

“…Several studies have indicated that the in ammatory response may play a critical role in AD initiation and progression [8,[11][12][13][14]. However, previous research mainly focused on the role of neutrophil counts in AD prognosis [8, [15][16][17] but not in AD diagnosis.…”