Prognostic factors and prediction models for acute aortic dissection: a systematic review

Abstract

ObjectiveOur study aimed to systematically review the methodological characteristics of studies that identified prognostic factors or developed or validated models for predicting mortalities among patients with acute aortic dissection (AAD), which would inform future work.Design/settingA methodological review of published studies.MethodsWe searched PubMed and EMBASE from inception to June 2020 for studies about prognostic factors or prediction models on mortality among patients with AAD. Two reviewers independently collected the information about methodological characteristics. We also documented the information about the performance of the prognostic factors or prediction models.ResultsThirty-two studies were included, of which 18 evaluated the performance of prognostic factors, and 14 developed or validated prediction models. Of the 32 studies, 23 (72%) were single-centre studies, 22 (69%) used data from electronic medical records, 19 (59%) chose retrospective cohort study design, 26 (81%) did not report missing predictor data and 5 (16%) that reported missing predictor data used complete-case analysis. Among the 14 prediction model studies, only 3 (21%) had the event per variable over 20, and only 5 (36%) reported both discrimination and calibration statistics. Among model development studies, 3 (27%) did not report statistical methods, 3 (27%) exclusively used statistical significance threshold for selecting predictors and 7 (64%) did not report the methods for handling continuous predictors. Most prediction models were considered at high risk of bias. The performance of prognostic factors showed varying discrimination (AUC 0.58 to 0.95), and the performance of prediction models also varied substantially (AUC 0.49 to 0.91). Only six studies reported calibration statistic.ConclusionsThe methods used for prognostic studies on mortality among patients with AAD—including prediction models or prognostic factor studies—were suboptimal, and the model performance highly varied. Substantial efforts are warranted to improve the use of the methods in this population.

Preliminary evaluation of the Chinese version of the patient-reported outcomes measurement information system 29-item profile in patients with aortic dissection

“…For a long time, AD mortality rates and adverse events have been widely published as key indicators for evaluating surgical outcomes [ 6 – 8 ]. Patient reported outcomes (PROs) are emerging as an important component for patient care in cardiovascular diseases and have been reported to be critical as clinical assessments in the evaluation of treatment outcomes [ 9 ].…”

Admission D-dimer to Lymphocyte counts ratio as a novel biomarker for predicting the in-hospital mortality in patients with acute aortic dissection

“…were observed in several studies that elevated D-dimer levels were associated with early mortality and postoperative compliactions (34,35). Admission D-dimer levels (>6.10 mg/ ml) were associated with an increased risk of in-hospital death (19). The D-dimer level in patients with AAD was in uenced by dissection type.…”

“…We retrospectively reviewed the medical records of the patients according to ID from our electronic database by two doctors ( Yansong Xu, Zheng Liang). Based on the current literature (19,20), we selected the following variables: Baseline characteristics, clinical features, laboratory results, imaging procedures, and outcomes of the patients. The baseline DLR was measured by dividing the D-dimr to the lymphocyte counts.…”

Early Prediction Model of Acute Aortic Syndrome Mortality in Emergency Departments

“…Recently, a systematic review of prediction models for acute aortic dissection concluded that the sample size varied from 35 to 1034 (median 165, IQR,103–348). 17 Tolenaar et al used multinational data from the International Registry of Acute Aortic Dissection (IRAD) that involved 1034 patients, but their aim was to investigate predictors of mortality among patients presenting with acute type B aortic dissection. 6 Czerny et al developed the German Registry of Acute Aortic Dissection Type A (GERAADA) score with 2537 patients involved, but the endpoint of their study was the 30-day mortality rate, and the patients who were diagnosed all underwent surgery, which is not suitable to use in ED.…”