Prognostic Value of Preoperative Hemoglobin Levels for Long-Term Outcomes of Acute Type B Aortic Dissection Post-thoracic Endovascular Aortic Repair

Gai

et al. 2023

BMC Cardiovasc Disord

Background Acute type B aortic dissection (ABAD) is a life-threatening cardiovascular disease. A practicable and effective prediction model to predict and evaluate the risk of in-hospital death for ABAD is required. The present study aimed to construct a prediction model to predict the risk of in-hospital death in ABAD patients. Methods A total of 715 patients with ABAD were recruited in the first affiliated hospital of Xinjiang medical university from April 2012 to May 2021. The information on the demographic and clinical characteristics of all subjects was collected. The logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and nomogram were applied to screen the appropriate predictors and to establish a prediction model for the risk of in-hospital mortality in ABAD. The receiver operator characteristic curve and calibration plot were applied to validate the performance of the prediction model. Results Of 53 (7.41%) subjects occurred in-hospital death in 715 ABAD patients. The variables including diastolic blood pressure (DBP), platelets, heart rate, neutrophil-lymphocyte ratio, D-dimer, C-reactive protein (CRP), white blood cell (WBC), hemoglobin, lactate dehydrogenase (LDH), procalcitonin, and left ventricular ejection fraction (LVEF) were shown a significant difference between the in-hospital death group and the in-hospital survival group (all P < 0.05). Furthermore, all these factors which existed differences, except CRP, were associated with in-hospital deaths in ABAD patients (all P < 0.05). Then, parameters containing LVEF, WBC, hemoglobin, LDH, and procalcitonin were identified as independent risk factors for in-hospital deaths in ABAD patients by adjusting compound variables (all P < 0.05). In addition, these independent factors were qualified as predictors to build a prediction model (AUC > 0.5, P < 0.05). The prediction model was shown a favorable discriminative ability (C index = 0.745) and demonstrated good consistency. Conclusions The novel prediction model combined with WBC, hemoglobin, LDH, procalcitonin, and LVEF, was a practicable and valuable tool to predict in-hospital deaths in ABAD patients.

Section: Discussionsupporting

confidence: 89%

A prediction model to predict in-hospital mortality in patients with acute type B aortic dissection

Gai

et al. 2023

BMC Cardiovasc Disord

“…[ 30 ] Low hemoglobin levels can lead to anemia. Gao Z, et al [ 31 ] have shown that patients with anemia were more likely to suffer from malnutrition, hemodilution, myocardial ischemia and renal insufficiency, and inadequate tissue oxygenation delivery caused by anemia may be an important cause of aortic dysfunction. Therefore, the concentration of hemoglobin is crucial for the prognosis of AD patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical analysis of 908 patients with aortic dissection under different Stanford types: A cross-sectional study

Zhang,

Gao

2023

Medicine

This study aims to investigate the difference of clinical characteristics and risk factors in aortic dissection (AD) of patients with 2 Stanford subtypes. A retrospective analysis was conducted on 908 patients admitted to Tongji Hospital from July 2019 to January 2021, and the aortic computed tomography angiography was used to clearly diagnose the artery dissection. Patient basic information as well as blood test indicators containing leukocytes, neutrophils, lymphocytes, hemoglobin, myoglobin, hypersensitive cardiac troponin, γ-glutamyl transferase, total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, ultrasensitive C-reactive protein, glucose were recorded and analyzed. There was no significant difference in gender, heart rate, smoking history, hypertension history and diabetes history between the 2 groups (P > .05), however, compared with type A patients, type B patients were older, and had a significantly higher frequency of alcohol consumption (P < .05); On laboratory tests, type A patients had significantly higher mean leukocytes and neutrophils (P < .05), and significantly lower frequency of reduced hemoglobin than type B patients (P < .05), although there was no statistical difference in lymphocyte, γ-glutamyl transferase, total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein and glucose counts between the 2 groups. Additionally, type A patients had a significantly higher number of abnormal myoglobin, hypersensitive cardiac troponin and ultrasensitive C-reactive protein test results than type B patients (P < .05). The receiver operating characteristic curve analysis showed that the area under the curve for each parameter was 0.605 (0.538–0.673) for hemoglobin, 0.610 (0.543–0.677) for leukocytes and 0.627 (0.561–0.693) for neutrophils. Understanding the relevant clinical indicators and risk factors of patients with different types of AD can provide a new perspective to assist the classification and diagnosis of AD and a basis for effective and rational treatment.

Osmangazi̇ Journal of Medicine

“…There are studies on Troponin in AD which suggest no relation to in-hospital mortality of AD patients (27,28). Only one study was found in our literature review about hemoglobin levels which has evaluated the pre-operative hemoglobin levels and it was conducted in Type B patients (29). We included all AD patients and found out that lower hemoglobin levels are associated with a lower survival rate (p=0.041).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Acute Aortic Dissections in the Emergency Department: A Retrospective Study

Çanakçı¹,

Şevik²,

Ay³

et al. 2021

Aortic dissection (AD) is a life-threatening emergency that has a mortality rate of around 27% even when optimal conditions are met. Atypical process of the disease which can mimic other critical conditions makes it harder to diagnose. The study aimed to determine Emergency department presentations and factors that influence the diagnostic process, emergency department, and in-hospital mortalities of acute AD patients. This study is a single-centered retrospective observational study. Patients with ICD-10 codes for AD in their digital files were analyzed. Patients were categorized into Stanford Type A or B dissections according to their computerized tomography scans. Also, the patients were compared in terms of survival. Eighty-eight patients had an acute AD and the mean age was 61,90±12,67 years. According to Stanford Classification, 68 patients had Type A dissection. Altered mental status and syncope were detected more in Type A (p=0.003 and p=0.001). Bilateral arm blood pressure readings differential was more in Type A (p=0.007). Blood products were used and endotracheal intubation was performed more in Type A (p=0.002 and p=0.005). Patients who had bilateral arm blood pressure differential had 3.5-fold, who had developed cardiac arrest in ED had 5.07-fold, who got blood product transfusions had 5.41-fold more risk of death. [OR:3.50; (CI 95% 1.36-8.94) p=0.009, OR: 5.07; (CI 95% 1.18-21.39) p=0.027 and OR: 5.41; (CI 95% 1.97-14.78) p=0.001 respectively]. The mortality rates in ED and in-hospital were 12.5% and 61.4% respectively. Aortic dissections will stay as important clinical conditions which management in ED is crucial. Atypical presentation of AD and the nature of the disease cause delays in diagnoses. AD should be considered in the foreground in patients presenting with syncope and altered mental status. When there is a clinical suspicion the scan of the aorta with computerized tomography must be ordered rapidly.